Infectious keratitis following penetrating keratoplasty: clinical and visual outcomes

Abstract

Purpose : To describe clinical features of infectious keratitis following keratoplasty

Methods : A 17-year (2001-2018) retrospective review of clinical records. Analyzed variables included: microbiology, previous ocular surgeries and medications, history of contact lens use, ocular surface disease, and lid abnormalities. Also treatment characteristics, indications for surgery and clinical outcomes were noted. Descriptive statistics, means, and SD were used for continuous variables; percentages were used to describe categorical variables. P, 0.05 was regarded as evidence of significance. All analyses were done with STATA v.10 software.

Results : A total of 105 eyes of 105 patients were included in this study. Mean age was 52.64 years, 48% were female. Mean time to infection after PKP was 20.11 (range 0.5 - 114 months). The mean number of previous grafts was 1.24 (range 1-7). Of the 105 cases 16 patients (15.24%) had 2 or more PKPs, and 89 patients (84.76%) had just one graft. 23 patients (21.90%) had clinical signs of blepharitis and 3 (2.83%) had palpebral alterations. 13 patients (12.50%) had glaucoma drainage device and just 10 patients (9.52%) were contact lens users.

Indications for corneal transplantation were bacterial keratitis in the 20% (n = 21) and trauma in 15.23% (n = 16). The corneal graft had failed in: 52 patients (49.52%), clear graft in 37 patients (35.23%) and 14 patients (14.7%) had rejection episode at the time of infection. Of those grafts that were clear only 19 cases remained clear (51.35%).
76 patients (72.38%) had sutures at the time of the episode, and of these, 25% the infection was judged to be related to sutures. Gram positive organism were responsible for 42% of the cases, gram negatives 30% , Herpetic 20% and fungi 8%. The most common gram+ bacteria was Staphylococcus epidermidis in 17 cases (16.19%) and the most common gram- was pseudomonas aeruginosa in 11 cases (10.47%).

Conclusions : Infectious keratitis following PKP is an important cause of graft failure, specifically bacterial. Patients with PKP require close monitoring to identify risk factors for developing infectious keratitis and posterior failure of the graft.

This is a 2021 ARVO Annual Meeting abstract.