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Microbial keratitis after penetrating keratoplasty: impact of sutures
Sonia Moorthy1, Enrique Graue, Vishal Jhanji
1Royal Victorian Eye and Ear Hospital, Centre for Eye Research Australia, University of Melbourne, Victoria, Australia.
Purpose:
To determine the impact of presence or absence of sutures in cases with post-penetrating keratoplasty (PKP) microbial keratitis.
Design:
A 10-year retrospective chart review of post-PKP patients admitted with microbial keratitis at the Royal Victorian Eye and Ear Hospital, Melbourne, between January 1998 and December 2008 was undertaken.
Methods:
Patients were categorized in 2 groups, "sutures present" and "sutures absent." Main parameters evaluated were clinical and microbiological profile and treatment outcome.
Results:
One hundred and twenty-two episodes of microbial keratitis were noted in 101 patients: 71 (58.2%) with sutures present and 51 (41.8%) with sutures absent. Overall, pseudophakic bullous keratopathy was the most common indication for keratoplasty (P=.92). Ocular surface disorder was the commonest risk factor associated with the occurrence of infection in both groups (P=.17). Infections caused by Moraxella sp. (P=.001) were significantly more common in the "sutures absent" group. Surgical interventions were required for 47 episodes (39%), with corneal gluing performed in significantly higher number of cases in the "sutures absent" group (40% vs 15%; P=.05). Multivariate analyses did not reveal any significant associations. Final mean visual acuity outcome was poorer in the "sutures absent" group (logMAR 2.10 ± 0.92 vs 1.76 ± 0.96; P=.04).
Conclusions:
Corneal graft infections, in the presence and absence of sutures, share similar indications and risk factors. However, infections caused by indolent microorganisms were more prevalent in grafts without sutures. This group of patients required a higher number of surgical interventions in the form of corneal gluing and the overall visual outcome was poor.
Insights
Microbial keratitis after penetrating keratoplasty (PKP) without sutures is linked to indolent organisms and poorer visual outcomes. These cases often require more surgical interventions like corneal gluing.
Area of Science:
- Ophthalmology
- Microbiology
- Corneal Surgery
Background:
- Post-penetrating keratoplasty (PKP) microbial keratitis is a significant complication.
- The role of sutures in influencing the clinical profile and outcomes of microbial keratitis post-PKP remains an area of interest.
Purpose of the Study:
- To investigate the impact of the presence or absence of sutures on microbial keratitis following PKP.
- To compare the clinical and microbiological characteristics and treatment outcomes between patients with and without sutures after PKP.
Main Methods:
- A retrospective chart review of 101 patients with 122 episodes of microbial keratitis post-PKP was conducted over a 10-year period.
- Patients were divided into two groups: 'sutures present' and 'sutures absent'.
- Clinical and microbiological data, along with treatment outcomes, were analyzed.
Main Results:
- Infections caused by Moraxella sp. were significantly more common in the 'sutures absent' group.
- Patients without sutures required more surgical interventions, particularly corneal gluing (40% vs 15%).
- Poorer final visual acuity was observed in the 'sutures absent' group (logMAR 2.10 vs 1.76).
Conclusions:
- Corneal graft infections post-PKP share similar indications and risk factors regardless of suture presence.
- Grafts without sutures showed a higher prevalence of infections caused by indolent microorganisms.
- Absence of sutures in post-PKP microbial keratitis is associated with increased surgical intervention needs and worse visual prognosis.
