Abstract
Purpose :
To assess the therapeutic penetrating keratoplasty (PK) cases for refractory infectious keratitis.
Methods :
Retrospective chart review was performed on patients who underwent therapeutic PK for refractory infectious corneal ulcer or perforation at the University of Tokyo Hospital from January 2004 to April 2015.
Results :
The number of eyes which received therapeutic PK during the period was 34 eyes. The average age of the patient was 66.4 (range 29 - 86). The average period from starting medication to therapeutic PK was 39.5 days (range 1 - 366). The mean follow up period was 41.4 months (range 1- 174). Thirty grafts were fresh donor corneas and 4 grafts were cryopreserved. Their background eye diseases consists of history of corneal surgery including keratoplasty, corneal herpes and various ocular surface diseases. Seventeen eyes received systemic or topical steroid preoperatively. Only one out of 34 eyes had no ocular or systemic diseases. The clinical diagnosis of pathogens were 79% fungi and 18% bacteria. The postoperative visual acuity was improved in 24 eyes (75%). Nine eyes (26%) received both intravenous and oral steroid and 7 (21%) received oral steroid since just after surgery. Postoperative topical steroid were used in 17 eyes (50%). The infection was successfully controlled in 31 eyes (91%) by therapeutic PK. However, one eye needed additional vitrectomy to control the infection and two needed eviscerations. Two out of those three received all intravenous, oral and topical steroid postoperatively.
Conclusions :
The therapeutic PK is a useful method to sustain the vision and to control the corneal infection which resists to the antimicrobial agent treatment. Postoperative steroid should be used with much caution.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.