Abstract
Purpose :
Interface keratitis following lamellar keratoplasty often requires significant intervention to prevent devastating outcomes; local information regarding this infection is lacking. This study is a retrospective case series to determine the incidence, clinical course, and management of interface keratitis in Canada.
Methods :
This is a retrospective multicentric medical chart review of patients that underwent lamellar keratoplasty, in which the donor cornea had a positive microbiological culture report. Descemet Membrane Endothelial Keratoplasty (DMEK), Deep Anterior Lamellar Keratoplasty (DALK), and Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) were included. Positive microbiological culture was defined as the growth or detection of any bacterial, fungal or parasitic species. Medical charts of patients with positive cultures were reviewed.
Results :
To date, this study included 3727 corneal transplants from 1997 to 2018, from a tertiary care centre in Vancouver, British Columbia. Of the 43 (1.2%) culture positive donor corneal rim reports, 8 (19%) reports belonged to patients undergoing lamellar keratoplasty. These 8 patients, involving 9 eyes, underwent DALK (1), DMEK (5) or DSAEK (2). The 9 eyes consisted of 5 (56%) left and 4 (44%) right eyes. Indications for lamellar keratoplasty included: Fuch’s dystrophy (6), keratoconus (1), and pseudophakic bullous keratopathy (1). Three keratoplasties were combined by cataract extraction and intra-ocular lens placement. Candida albicans (37.5%) and Enterococcus faecalis (37.5%) were the most common species, while Rhodotorula mucilaginosa (12.5%), Candida glabrata (12.5%), and Candida dubliniensis (12.5%) were also isolated. Despite the positive rim cultures, there have been no clinical cases of interface keratitis. The DALK patient had a small inferior opacity and loose suture 4 days post-keratoplasty, but this resolved quickly with suture removal and topical moxifloxacin, and was not felt to be clinically significant.
Conclusions :
Interface keratitis following lamellar keratoplasty is an emerging problem in modern corneal surgery. The microbiological results observed are consistent with those seen in reported series of interface keratitis, the majority of which implicate Candida species. The rarity of the condition requires a multicentric study design. This study seeks to include data from other Canadian provinces.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.