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Microbial keratitis--a late complication of penetrating keratoplasty
1Department of Ophthalmology, Chang-Gung Memorial Hospital, Chang-Gung University, Taipei, Taiwan. huangsam@ms9.hinet.net
Abstract:
A retrospective review of 323 penetrating keratoplasties performed in Taiwan between January 1993 and December 1997 revealed that late microbial keratitis developed in 39 eyes of 36 patients (12.1%). All patients were operated on by the same surgeon, and all were followed for at least 1 year. The mean interval between the corneal transplantation and the onset of graft infection was 8.6 +/- 8.8 months (range 3 weeks-47 months). Predisposing risk factors for keratitis included chronic blepharitis with poor lid hygiene (43.6%), suture-related problems (38.5%), dry eyes (28.2%), epithelial defects (25.6%), and use of contact lenses (5.1%). Infectious keratitis was diagnosed within 6 months after keratoplasty in 59% of cases. Positive cultures were obtained in 100% of the ulcers; Pseudomonas aeruginosa and Staphylococcus aureus were the most common pathogens. In the final visual outcome assessment, 30.8% of cases had clear grafts, 20.5% had graft failures, and 10.3% had corneal perforations.
Insights
Late microbial keratitis affects over 12% of corneal transplant recipients, often linked to factors like blepharitis and suture issues. Early diagnosis and management are crucial for better visual outcomes after penetrating keratoplasty.
Area of Science:
- Ophthalmology
- Microbiology
- Transplantation Science
Background:
- Late microbial keratitis is a significant complication following penetrating keratoplasty.
- Understanding risk factors and outcomes is essential for improving patient care.
Purpose of the Study:
- To investigate the incidence, predisposing factors, and outcomes of late microbial keratitis after penetrating keratoplasty.
- To identify common pathogens and their susceptibility patterns.
Main Methods:
- Retrospective review of 323 penetrating keratoplasty cases performed between January 1993 and December 1997.
- Analysis of patient records for demographic data, surgical details, clinical presentation, microbiology, and visual outcomes.
Main Results:
- The incidence of late microbial keratitis was 12.1% (39 eyes/36 patients).
- Common risk factors included chronic blepharitis (43.6%), suture problems (38.5%), dry eyes (28.2%), and epithelial defects (25.6%).
- Pseudomonas aeruginosa and Staphylococcus aureus were the most frequent pathogens; 59% of cases occurred within 6 months post-keratoplasty, with 10.3% resulting in corneal perforation.
Conclusions:
- Late microbial keratitis poses a substantial risk after penetrating keratoplasty, with several identifiable predisposing factors.
- Effective management of lid hygiene, ocular surface, and suture-related issues may help reduce the incidence of post-keratoplasty infections.