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Valerie P J Saw, Evangelia Gkaragkani, Claudia Da Costa Paula, Francesco Aiello, zisis Gkatzioufas; Outcomes of Therapeutic Penetrating Keratoplasty for Microbial Keratitis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1328. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Management of severe microbial keratitis associated with corneal melting or perforation remains a challenge, as therapeutic penetrating keratoplasty may be necessary. Keratoplasty in this setting is associated with an increased risk of graft rejection and failure, as well as potential recurrence of infection. In this study we evaluated success with eradication of infection, anatomic success with restoration of tectonic integrity, and graft survival, and identified factors associated with a less favourable prognosis.
Retrospective case series of all patients with microbial keratitis requiring therapeutic penetrating keratoplasty at Moorfields Eye Hospital between January 2004 to December 2014. Data collection included: demographic data, medical history, slit-lamp exam, surgical data, postoperative outcomes and postoperative complications. Descriptive analysis was performed.
35 eyes of 33 patients were evaluated. Bacterial keratitis (28.5%), acanthamoeba (28.5%) or fungal (28.5%) were more frequent than viral keratitis (14.5%). 55% of patients were contact lens wearers, including 80% of the fungal keratitis cases. Visual acuity improved overall in 72% of eyes, except in acanthamoeba patients, where acuity improved in only 27%.Recurrence of infection was highest with viral cases, 43%. 89% of cases had anatomical success. Graft rejection occurred in 14% bacterial, 18% fungal, 29% viral and 55% acanthamoeba keratitis. Graft survival at 1 year follow up was similar for bacteria, fungal and viral (64%, 73% and 71% respectively) and 36% for acanthamoeba keratitis.
Therapeutic penetrating keratoplasty is successful in restoring globe integrity as well as improving eyesight in the majority of cases of corneal perforation and melt. Acanthamoeba cases are associated with the worst prognosis, with a less successful visual improvement and higher graft rejection. Comparison with outcomes of therapeutic lamellar keratoplasty would be useful.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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