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[Study of infectious keratitis in corneal graft]
Sánchez Pérez A1, Bueno Lozano J, Brito Suárez C
1Servicio de Oftalmología, Hospital Miguel Servet, Zaragoza, España. ib308785@public.ibercaja.es
Purpose:
This retrospective study was conducted to identify the associated risk factors and microbiologic spectrum in infectious keratitis (IK) after penetrating keratoplasty (PK).
Methods:
Medical records of 246 PK (corneal grafts for a 17-year period, 1980-1997) were reviewed to identify IK. Criterion for inclusion was IK in PK and positive corneal culture or smear Gram stain. PK indications, interval PK-IK, risk associations microbiologic study, complications, and final corneal graft clarity were reviewed.
Results:
The incidence reported was 4.8%, 12 cases of IK identified in 246 PK performed. The most common PK diagnosis was herpes simplex keratopathy. Potential risk factors have been categorized in :1- Local ocular (graft discompensation, therapeutic contact lens, suture-related), 2- Topical medication (corticosteroids and antibiotics) and 3- Systemic causes (diabetes mellitus). Time interval between PK-IK was 27.1+/-25.7 months (25% occurred within 12 months PK and suture complications were the main cause; 75% later than 12 months and corneal oedema and therapeutic contact lens the main late causes). Microbial spectrum: 66.6% cases were bacterial, Gram (+) organisms were predominantly involved (Streptococcus and Staphylococci) and the remaining cases were fungal (Candida). There was one case of infectious crystalline keratopathy due to Streptococcus Mitis. The prevalence of complications like evisceration and failure clear graft were 75%.
Conclusions:
IK after PK is an uncommon (4.8%) but serious complication. It proves a major later form incidence, associated to graft discompensation and contact lens use. Gram (+) bacterial organism and fungi (Candida) were predominantly involved.
Insights
Infectious keratitis (IK) after penetrating keratoplasty (PK) is a rare but serious complication. Risk factors include graft decompensation and contact lens use, with Gram-positive bacteria and fungi being common causes.
Area of Science:
- Ophthalmology
- Microbiology
- Corneal Transplantation
Context:
- Penetrating keratoplasty (PK) is a common procedure for corneal blindness.
- Infectious keratitis (IK) is a potential sight-threatening complication following PK.
- Identifying risk factors and causative agents is crucial for prevention and treatment.
Purpose:
- To retrospectively identify associated risk factors for IK after PK.
- To determine the microbiologic spectrum of IK in PK recipients.
- To analyze complications and graft clarity outcomes in IK cases.
Summary:
- This study reviewed 246 PK cases over 17 years, identifying 12 instances of IK (4.8% incidence).
- Key risk factors included graft decompensation, therapeutic contact lens use, suture issues, topical medications, and diabetes mellitus.
- Bacterial pathogens (Gram-positive cocci like Streptococcus and Staphylococci) were most common, followed by fungi (Candida). Complications were frequent, with 75% experiencing graft failure or requiring evisceration.
Impact:
- Highlights IK as an uncommon but severe complication of PK, often occurring late.
- Emphasizes the role of graft decompensation and contact lens use as significant risk factors.
- Informs clinical practice regarding monitoring and management of PK patients at risk for IK.