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Published on: May 12, 2020
[Therapeutic penetrating keratoplasty for microbial keratitis]
Z Habot-Wilner1, T Wygnanski-Jaffe, A Fink
1Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University. zwilner@hotmail.com
Background:
Microbial keratitis is a potentially sight threatening disease. Most cases respond well to antimicrobial therapy. However, in cases that progress despite intensive medical therapy, an urgent therapeutic penetrating keratoplasty (TPKP) is required.
Aim:
To evaluate the indications and results of TPKP in Israel.
Methods:
A retrospective study reviewed the TPKP performed at the Goldschleger Eye Institute, Sheba Medical Center, between 1990-2003. The study included 18 cases of at least one-year follow-up.
Results:
The indications for TPKP included severe infectious keratitis unresponsive to medical treatment in 33% of the patients and severe corneal destruction in 66% of them. The infectious keratitis was diagnosed as bacterial keratitis in 44% of the patients, unidentified pathogen in 39%, mycotic in 11% and acanthamoeba in 6% of the patients. Risk factors in the patients with microbial keratitis requiring TPKP included: previous ocular disease in 39%, previous ocular surgery in 66%, systemic disorders in 28% and ocular risk factors in 28% patients. TPKP was successful in bacterial and acanthamoeba keratitis as far as the transparency of the graft and elimination of the infection and improvement of visual acuity. However, TPKP failed in mycotic and unidentified keratitis. The risk factors for failure included: previous ocular disease or surgeries, systemic disorders or large corneal grafts.
Conclusions:
Therapeutic penetrating keratoplasty is an important and effective therapeutic tool for intractable bacterial and acanthamoeba keratitis. Prognostic factors for graft success include lack of ocular disease or previous surgeries, lack of systemic disorders or small corneal graft size.
Insights
Therapeutic penetrating keratoplasty (TPKP) effectively treats intractable bacterial and acanthamoeba keratitis. Graft success depends on patient history, systemic health, and graft size, avoiding complications from prior eye disease or surgery.
Area of Science:
- Ophthalmology
- Microbiology
- Transplantation Surgery
Context:
- Microbial keratitis poses a significant threat to vision, often requiring intensive antimicrobial therapy.
- Advanced or unresponsive cases necessitate urgent therapeutic penetrating keratoplasty (TPKP) to preserve sight.
- Understanding TPKP indications and outcomes is crucial for managing severe infectious keratitis.
Purpose:
- To evaluate the indications for and outcomes of therapeutic penetrating keratoplasty (TPKP) in Israel.
- To identify risk factors associated with TPKP failure in cases of severe microbial keratitis.
Summary:
- A retrospective review of 18 TPKP cases (1990-2003) indicated severe infectious keratitis (33%) or corneal destruction (66%) as primary reasons.
- Bacterial and Acanthamoeba keratitis showed successful TPKP outcomes, including graft clarity, infection control, and visual acuity improvement.
- TPKP failure was observed in mycotic and unidentified keratitis, with risk factors including prior ocular disease/surgery, systemic disorders, and large grafts.
Impact:
- TPKP is a vital treatment for intractable bacterial and Acanthamoeba keratitis, restoring vision and eliminating infection.
- Identifying prognostic factors like absence of prior ocular disease/surgery, systemic health, and smaller graft size can optimize TPKP success rates.
- This study informs clinical decision-making for TPKP, improving patient outcomes in severe microbial keratitis cases.
