15 A 100-year-old donor saves 2 cases of fungal sclerokeratitis associated with panendophthalmitis

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Purpose Fungal ocular infections are among the most technical medical and surgical challenges. Since cornea, sclera, vitreous or aqueous humour are contaminated, it may lead to enucleation or evisceration ‘a chaud’.Venue CHNV15-20, Infectiology and Transplantation department, GRC32, TITC, Sorbonne University, Paris.Methods Two case-series with fungal sclerokeratitis associated with panendophthalmitis in a French tertiary cen-ter one week apart: a 55-year-old woman with Paecilomyces lilacinus infection since several months; and a 74-year-old man with Microsporidies (parasite, ex-fungal agent) infection since several weeks living in the French West Indies. The woman’s background was bilateral keratoconus 6 previous penetra-ting keratoplasty (PK) in the infected right eye including 5 during the last 9 months due to Paecilomy-ces lilacinus keratitis. Last PK was done 1 month and half ago with intraocular lens removal managed in another center. Vision was light perception. The man’s background was moderated controlled diabetes, bilateral ectropion, bilateral DMEK on bullous keratopathy, and then PK on the left eye due to Microspo-ridies keratitis. Vision was light perception. Rather than primary evisceration, we attempted to propose a rescue surgery combining temporary keratoprosthesis, vitrectomy, sclerocorneal transplantation, limbal reconstruction.Results An 8mm temporary keratoprosthesis was placed after surface debridement and multiple tissue sam-pling (cornea, limbus, tenon, sclera) to allow complete vitrectomy (multiples samples), then sclerocor-neal transplantation (15mm diameter), limbal reconstruction with human amniotic graft (AMG) inlay on limbus and then overlay over thesclerocorneal graft. Tamponade was either gas to treat giant macular hole induced by retinal infectious foci for the woman; either heavy silicone tamponade due to specific germ and macular infectious foci for the man. Each recipient received an emergency 1800cell/mm2 sclerocorneal graft from the same 100-year-old donor (deceased by stroke). Both intravitreal and intra-cameral antibiotics and antifungal agents were used during the rescue surgery. Repeated injections were necessary during the first weeks. No serious adverse event occurred. Intraocular pressure was normal. Anatomy was restored without primary graft failure. Function was partially restored (20/80 for the wo-man at M1, 20/200 for the man at M1), without active infection or pain.Conclusions Given the rarity of these germs and this surgical techniques combination and these advanced infections, only descriptive message may be addressed. Initial corneoscleral transplantation was a valuable option by removing most of the infectious load, preventing from early phthisis or evisceration.A same donor can really save 2 recipients: age does not matter; even a super old donor can change sight and life for younger patients in emergency.

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