Antibiotic resistance of crystalline bacterial ingrowth in a corneal graft.

Four recent reports have described the clinical appearance of fine needle-like opacities in the corneal stroma of six patients. In five of these patients these developed in a corneal graft. Histologically, all the corneal buttons had bacterial ingrowth between the stromal lamellae, with a striking lack of inflammatory response. We report a patient in whom this process occurred following penetrating keratoplasty. Intensive topical antibiotic treatment failed, and she underwent a second, successful, penetrating keratoplasty. Postoperatively, this patient has maintained good vision with no recurrence for over three years. Histologic and ultrastructural study of the corneal button revealed viable and nonviable gram-positive cocci with a marked paucity of inflammatory infiltrate.