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Surv Ophthalmol. 2018 Jul - Aug;63(4):480-499. doi: 10.1016/j.survophthal.2017.10.008. Epub 2017 Oct 31.

Infectious crystalline keratopathy.

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City Eye Centre, Brisbane, Queensland, Australia.
City Eye Centre, Brisbane, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia; Mater Health Services, Brisbane, Queensland, Australia. Electronic address:
Wilmer Eye Institute, Baltimore, Maryland, USA.


Infectious crystalline keratopathy was first reported by Gorovoy and colleagues in 1983 when they identified bacteria colonizing a cornea after a penetrating keratoplasty. Subsequent cases have elaborated on the organisms responsible and the management outcomes. Patients present with a white or gray branching opacity originating from an epithelial defect, commonly after a penetrating keratoplasty. Local immunosuppression contributes to the quiescent nature and the limited inflammatory response associated with infectious crystalline keratopathy. Diagnosis of the infective pathogens may be difficult, with a corneal scraping often being too superficial to obtain an adequate specimen. A biofilm is present that advantages microorganism survival, reduces antibiotic bioavailability, and inhibits diagnostic microbial detection. Treatment begins with topical antimicrobials, initially broad spectrum and then targeted to microorganism sensitivity. Adjunctive therapies to enhance the efficacy of treatment include disruption of the microorganism biofilm by laser, intrastromal antibiotics, and keratectomy. In recalcitrant cases, or where corneal scarring ensues, corneal transplantation is required.


biofilm; infectious crystalline keratopathy; keratitis; keratoplasty

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