June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Clinical presentation, management and outcome of post-keratoplasty infectious keratitis: A 7-year study
Author Affiliations & Notes
  • Zun Zheng Ong
    Academic Ophthalmology, University of Nottingham School of Medicine, Nottingham, England, United Kingdom
  • Lakshmi Suresh
    Academic Ophthalmology, University of Nottingham School of Medicine, Nottingham, England, United Kingdom
  • Yasmeen S. J. Hammoudeh
    Academic Ophthalmology, University of Nottingham School of Medicine, Nottingham, England, United Kingdom
  • Dalia G. Said
    Academic Ophthalmology, University of Nottingham School of Medicine, Nottingham, England, United Kingdom
  • Harminder S Dua
    Academic Ophthalmology, University of Nottingham School of Medicine, Nottingham, England, United Kingdom
  • Darren Shu Jeng Ting
    Academic Ophthalmology, University of Nottingham School of Medicine, Nottingham, England, United Kingdom
    Ophthalmology, Birmingham and Midland Eye Centre, Birmingham, Birmingham, United Kingdom
  • Footnotes
    Commercial Relationships   Zun Zheng Ong None; Lakshmi Suresh None; Yasmeen Hammoudeh None; Dalia Said None; Harminder Dua None; Darren Shu Jeng Ting None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 594. doi:
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      Zun Zheng Ong, Lakshmi Suresh, Yasmeen S. J. Hammoudeh, Dalia G. Said, Harminder S Dua, Darren Shu Jeng Ting; Clinical presentation, management and outcome of post-keratoplasty infectious keratitis: A 7-year study. Invest. Ophthalmol. Vis. Sci. 2023;64(8):594.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Post-keratoplasty infectious keratitis (PKIK) is a unique clinical entity that, if untreated, can be sight-threatening. Urgent treatment is essential to reduce the risk of graft failure and loss of vision. This study aimed to examine the clinical presentation, risk factors, management and clinical outcomes of PKIK.

Methods : This was a retrospective observational study. All patients who presented to the Queen’s Medical Centre, Nottingham, with infectious keratitis following between September 2015 and Aug 2022 (a 7-year period) were included. Relevant data on the types of keratoplasty, clinical presentations, causative microorganisms, corrected-distance-visual outcome (CDVA), management, and outcome were analysed.

Results : A total of 49 (9.8%) PKIK cases were identified among the 501 IK cases (with full data) during the study period. The mean age was 64.6±20.4 years and 51% were male patients. PKIK was most commonly observed following penetrating keratoplasty (PK; n=24, 49.0%), followed by endothelial keratoplasty (EK; n=14, 28.6%) and deep anterior lamellar keratoplasty (DALK; n=11, 22.4%). Of 30 culture-positive cases, Staphylococcus spp. were the most commonly identified organism (15, 50.0%). Bullous keratopathy (18, 36.7%), suture-related complications (15,30.6%), and previous infection (4, 8.2%) were the most common reasons for PKIK. Topical steroid use was identified in 25 (51.0%) cases. Of 31 functioning grafts at presentation, 10 (32.3%) graft failed at final follow-up, with 12 (38.7%) patients retaining a CDVA of 6/60 or better.

Conclusions : PKIK represents an important cause of IK and graft failure, and it often poses significant therapeutic challenges in clinic. Bullous keratopathy and suture-related complications and represent the two commonest reasons for PKIK. Early suture removal (where possible) and prophylactic topical antibiotics may help reduce the risk of suture-related and bullous keratopathy-related PKIK, respectively.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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