Abstract
Purpose: :
To analyse the incidence of endophthalmitis following corneal transplantation.
Methods: :
All patients registered with the United Kingdom Transplant (UKT) undergoing corneal transplantation between the period 1999 and 2006 were included. Patient outcome data collected at surgery and at 1, 2 and 5years included graft survival, visual acuity, rejection episodes, medications and infections including endophthalmitis. Where endophthalmitis had been reported, the donor details were reviewed and the treating ophthalmologist was sent a questionnaire for further details on organism isolated, treatment and outcome.
Results: :
There were 16 067 corneal transplants registered with UKT between the period 1999 to 2006, of which 14439 (90%) have reported follow-up. During this period 103 (0.71 percent, SD 0.08) cases of endophthalmitis were reported. The incidence has remained relatively stable during this 7 year period.The number of cases of endophthalmitis were related to the indication for the transplant. The highest incidences according to the number of corneal transplants undertaken, occurred where the indication was re-graft for endophthalmitis, 18.2% (2/11), fungal infection, 10.8% (4/37), and rheumatoid arthritis, 6.1% (11/181). Keratoconus had the lowest incidence, 0.32% (11/3465). Of the 103 cases, however, 12.6% (13/103) followed surgery for pseudophakic corneal oedema, 12.6% (13/103) for Fuchs’ endothelial dystrophy, 10.7% (11/103) for rheumatoid arthritis associated corneal ulceration and 10.7% (11/103) following surgery for keratoconus. The highest incidence per grafts done occurred in the 50-60 age range, 1.03% (15/1453), with the lowest in the 0-10yr, 0% (0/102), and 11-20yr 0.18% (1/566), age groups. In terms of donor factors, the incidence of endophthalmitis where the cause of death was septicaemia, was 3.2% (6/188).
Conclusions: :
Endophthalmitis remains a serious adverse reaction following corneal transplantation. The most high risk cases for the development of endophthalmitis following corneal transplantation are re-graft for previous endophthalmitis, fungal infections and rheumatoid arthritis associated corneal ulceration.
Keywords: cornea: clinical science • endophthalmitis • transplantation