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B. J. Lee, B. H. Jeng; Suture-Related Infections After Penetrating Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2008;49(13):834.
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Suture-related complications have been reported to occur in approximately 3 to 5% of eyes following penetrating keratoplasty (PK). The purpose of this study was to determine the rate of and characteristics of suture-related infections in eyes after PK at our institution.
We performed a retrospective chart review of all patients who underwent PK from January 1, 2002 to July 1, 2007 and who were also diagnosed with a corneal ulcer during this time period. Charts were reviewed to confirm that the corneal infections were associated with sutures from the PK. Data reviewed included indication for PK, time interval between surgery and infection, use of topical corticosteroids or antibiotics when infection occurred, patient symptoms, clinical findings, micro-organisms cultured, anti-microbial therapy, response to therapy, and change in visual acuity.
Of the 614 PK’s performed during the study period, there were 5 suture-related corneal infections. Four patients developed infections between 3 to 7 months after PK, and one patient developed an infection 23 months after PK. Patients reported symptoms of discomfort from one day to 3 weeks prior to presentation. At the time of diagnosis of the suture-related infections, all patients were using topical prednisolone acetate 1% eyedrops between 2 to 4 times a day, and none were on topical antibiotic eyedrops. Two of the five patients were found to have suture abscesses only, while the remaining three patients developed suture abscesses with associated endophthalmitis. All infections were associated with sutures in the interpalpebral zone. The two patients who had isolated suture abscesses were treated with intensive broad-spectrum antibiotic drops while the remaining three patients were treated with intravitreal injections of antibiotics along with topical fortified antibiotic eyedrops. Mean change in visual acuity was a loss of 2.6 Snellen equivalent lines, with a range of 0 to 6 lines. None of the patients underwent repeat PK, but two eyes with endophthalmitis progressed to phthisis bulbi despite control of the infection.
The rate of suture-related infections at our institution was 0.81%, which is lower than previously published series. Isolated suture abscesses can respond favorably to topical antibiotic treatment, but suture abscesses associated with endophthalmitis can result in poor outcomes despite aggressive therapy. Because of the potentially high morbidity of suture-related complications after PK, patients should be educated regarding symptoms of exposed sutures and be instructed to contact their physician promptly for evaluation when they experience these symptoms.
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