Late-onset deep infectious keratitis after descemet stripping endothelial keratoplasty with vent incisions

To report the clinical and histopathological findings of 3 cases of late-onset deep infectious keratitis after Descemet stripping endothelial keratoplasty (DSEK) with vent incisions.From a retrospective review of 150 consecutive patients who underwent uncomplicated DSEK with vent incisions, 3 patients developed late-onset deep infectious keratitis.In case 1, the patient suffered a Pseudomonas corneal ulcer at the nasal vent incision after a dacryocystorhinostomy with stent, 16 months after DSEK. In case 2, a Streptococcus pneumoniae infection developed at the inferior vent incision from a spastic entropion 3 months after surgery. In case 3, an Enterococcus faecalis corneal ulcer presented as a deep stromal abscess in the nasal vent incision 7 weeks after DSEK. All cases required full-thickness penetrating keratoplasties. Visual acuities at the last follow-up were counting fingers (case 1), 20/80 (case 2), and 20/400 (case 3).Vent incisions in DSEK may allow bacterial keratitis to penetrate deeply leading to aggressive keratolysis. One must be cautious in using vent incisions in patients with increased bacterial flora and patients with poor ocular surface healing from systemic, local, or mechanical conditions. If vent incisions are performed, a midperipheral oblique incision, parallel to the limbus, with meticulous detail to wound construction is recommended.