April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Endophthalmitis following primary penetrating keratoplasty in the United Kingdom
Author Affiliations & Notes
  • Jern Yee Chen
    St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
  • Mark N Jones
    NHS Blood and Transplant, Bristol, United Kingdom
  • Sathish Srinivasan
    University Hospital Ayr, Ayr, United Kingdom
  • John Armitage
    Bristol Eye Bank, University of Bristol, Bristol, United Kingdom
  • Timothy Neal
    Medical Microbiology, Royal Liverpool University Hospital, Liverpool, United Kingdom
  • Stephen Kaye
    St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
  • Footnotes
    Commercial Relationships Jern Yee Chen, None; Mark Jones, None; Sathish Srinivasan, None; John Armitage, None; Timothy Neal, None; Stephen Kaye, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 3139. doi:
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      Jern Yee Chen, Mark N Jones, Sathish Srinivasan, John Armitage, Timothy Neal, Stephen Kaye, ; Endophthalmitis following primary penetrating keratoplasty in the United Kingdom. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3139.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: To determine the incidence of endophthalmitis following primary penetrating keratoplasty (PK) and to identify associated patient and donor risk factors.

Methods: Retrospective review of all recipients undergoing their first PK (N=11320) registered on the United Kingdom Transplant Registry between April 1999 and December 2006. Clinical information collected included pre-operative (donor and recipient characteristics) and peri-operative events (additional procedures, suturing method, grade of surgeon) and post-operative outcomes (visual acuity, medications, complications, rejection episodes, graft survival and reasons for graft failure) in index cases of endophthalmitis and cases where the fellow donor mate cornea had been transplanted. Logistic regression was used to investigate multivariate differences in the factors associated with the development of endophthalmitis. Cox proportional hazards regression was used to determine whether graft survival was lower for endophthalmitis cases in comparison with fellow donor corneal transplants.

Results: The overall incidence of endophthalmitis occurring post primary PK in the UK was 0.67% (N=76). The incidence of acute endophthalmitis occurring within 6 weeks of surgery was 0.16% (N=18). Factors associated with endophthalmitis were donor cause of death (infection, OR=4.4, CI=1.8-10.8, P=0.001), high risk graft indications (OR=2.8, CI=1.6-5.0, P=0.0002) and non-visual graft indication (OR=1.9, CI=1.2-3.1, P=0.007). Endophthalmitis cases had lower graft survival (27% versus 75%, P <0.0001) and poorer visual outcomes(17% vs 62% achieving BCVA better than 6/12, P=0.003).

Conclusions: The development of endophthalmitis remains a serious issue, with those affected having reduced graft survival and reduced visual outcomes. The risk factors for the development of endophthalmitis were found to be both donor and recipient related. As such, it is therefore important that eye retrieval and eye bank practices are reviewed, particularly with regard to the use of disinfections at the time of enucleation and the testing of eyes for possible contamination prior to preservation to ensure the provision of high quality and safe tissue to recipients. It is equally important for surgeons to have extra vigilance in high risk cases and to consider the use of additional prophylactic measures to reduce the risk in such cases.

Keywords: 513 endophthalmitis • 741 transplantation  
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