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Published on: November 17, 2014
Microbial keratitis following corneal transplantation
Tarra M Wright1, Natalie A Afshari
1Duke University Eye Center, Duke University Medical Center, Durham, North Carolina 27710, USA.
Purpose:
To study clinical and microbiologic characteristics of corneal infections following penetrating keratoplasty (PK).
Design:
Retrospective case series.
Methods:
Medical records of patients who presented to Duke University Eye Center from January 1, 1999 to July 1, 2005 with microbial keratitis after PK were reviewed.
Results:
Forty-four corneal graft infections were reviewed. Mean interval between PK and infection was 26.3 months. Associated conditions included broken or loose sutures (10, 22.7%) and topical corticosteroids (34, 77.3%). Staphylococcal (12, 20.7%) and Pseudomonal (7, 12.1%) species were common pathogens, and fungal species accounted for eight (18.2%) infections. Twelve patients (27.3%) had polymicrobial infections. Thirteen patients (29.5%) underwent repeat PK. Mean postinfection visual acuity at last follow-up was 20/400.
Conclusions:
Microbial infections within corneal grafts can occur anytime in the postoperative course and are associated with broken sutures and the use of topical corticosteroids. The diversity of pathogenic organisms, antibiotic resistance, and the potential for poor outcomes supports aggressive management of these infections.
Insights
Corneal infections after penetrating keratoplasty (PK) can occur long after surgery, often linked to suture issues and steroid use. Aggressive management is crucial due to diverse pathogens and poor visual outcomes.
Area of Science:
- Ophthalmology
- Microbiology
- Transplantation
Background:
- Corneal infections post-penetrating keratoplasty (PK) pose a significant threat to graft survival and visual acuity.
- Understanding the clinical and microbiological spectrum of these infections is vital for effective treatment strategies.
Purpose of the Study:
- To investigate the clinical and microbiological features of corneal infections occurring after penetrating keratoplasty (PK).
Main Methods:
- A retrospective case series design was employed.
- Medical records of patients diagnosed with microbial keratitis following PK between January 1, 1999, and July 1, 2005, were analyzed.
Main Results:
- Forty-four cases of corneal graft infections were reviewed, with a mean interval of 26.3 months post-PK.
- Commonly associated factors included broken sutures (22.7%) and topical corticosteroid use (77.3%).
- Staphylococcal (20.7%) and Pseudomonal (12.1%) species were frequent pathogens, alongside fungal infections (18.2%); 27.3% of cases were polymicrobial. Mean visual acuity at last follow-up was 20/400.
Conclusions:
- Microbial keratitis can manifest at any point in the post-PK period, often associated with suture complications and corticosteroid therapy.
- The varied microbial profiles, antibiotic resistance, and potential for severe vision loss necessitate prompt and aggressive treatment approaches.
