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Jern Yee Chen, Mark N Jones, Sathish Srinivasan, John Armitage, Timothy Neal, Stephen Kaye, NHSBT Ocular Tissue Advisory Group; Endophthalmitis following primary penetrating keratoplasty in the United Kingdom. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3139.
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To determine the incidence of endophthalmitis following primary penetrating keratoplasty (PK) and to identify associated patient and donor risk factors.
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.
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).
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.
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