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Microbial keratitis after penetrating keratoplasty
A K Bates1, C M Kirkness, L A Ficker
1Department of Clinical Ophthalmology, Institute of Ophthalmology, Moorfields Eye Hospital, London.
Abstract:
Thirty cases of microbial keratitis after penetrating keratoplasty were reviewed to examine the associated risk factors, the spectrum of pathogens and the prognosis for graft survival and visual outcome. The indications for keratoplasty in this group differed markedly from those for all corneal grafts performed with a much higher incidence of previous microbial keratitis and of herpes simplex keratitis. A positive culture was obtained in 93% of cases and in contrast to microbial keratitis overall, Gram positive organisms predominated particularly streptococcus pneumoniae and staphylococcus aureus. Risk factors identified were loose or broken sutures, graft decompensation and a poor ocular surface environment. There was a poor prognosis for graft survival with only 23% of cases retaining a clear graft. Overall 53% of cases were regrafted.
Insights
Microbial keratitis following corneal transplants is common, with Gram-positive bacteria like Streptococcus pneumoniae and Staphylococcus aureus predominating. Poor graft survival and visual outcomes necessitate further research into prevention and treatment.
Area of Science:
- Ophthalmology
- Microbiology
- Transplantation
Background:
- Microbial keratitis is a significant complication following penetrating keratoplasty.
- Understanding risk factors and causative pathogens is crucial for improving graft survival.
Purpose of the Study:
- To identify risk factors, pathogens, and prognosis of microbial keratitis after penetrating keratoplasty.
- To compare indications for keratoplasty in this cohort versus the general population.
Main Methods:
- Retrospective review of thirty cases of microbial keratitis post-penetrating keratoplasty.
- Analysis of microbial cultures, risk factors, graft survival, and visual outcomes.
Main Results:
- Indications for keratoplasty differed significantly, with higher rates of prior microbial keratitis and herpes simplex keratitis.
- Gram-positive organisms, particularly Streptococcus pneumoniae and Staphylococcus aureus, predominated (93% positive cultures).
- Identified risk factors included loose sutures, graft decompensation, and poor ocular surface environment.
Conclusions:
- Microbial keratitis post-keratoplasty has a poor prognosis, with only 23% clear grafts and 53% requiring regrafting.
- Specific risk factors and a distinct microbial spectrum highlight the need for targeted management strategies.