Bacterial endophthalmitis following suture removal after penetrating keratoplasty

Of three cases of bacterial endophthalmitis occurring after removal of corneal sutures following penetrating keratoplasty, two were associated with wound dehiscence and one was not. Factors that may predispose to wound dehiscence and subsequent infection are: use of fine suture material, corticosteroids, and chronic topical antibiotics; early removal of corneal sutures; lack of adherence to strict asepsis prior to and after suture removal; and open suture tracts that may be kept open by incarceration of vitreous strands. Late corneal wound dehiscence may occur with subsequent development of endophthalmitis as long as three days after suture removal. The use of topical antibiotics before and after suture removal may decrease the potential for infection. In addition, early recognition of intraocular infection by the patient and the surgeon for immediate institution of antimicrobial and anti-inflammatory therapy may preserve useful vision.