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Shifting trends in microbial keratitis following penetrating keratoplasty in Taiwan
Hung-Chi Chen1, Chia-Yi Lee, Hung-Yu Lin
1Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Department of Medicine, Chang Gung University College of Medicine, Taoyuan Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan Department of Optometry, Chung Shan Medical University, Taichung Department of Optometry, Yuanpei University of Medical Technology, Hsinchu, Taiwan. Department of Chinese Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Abstract:
To investigate the clinical and microbiological profiles from microbial keratitis following penetrating keratoplasty (PKP) in a tertiary referral center in Taiwan, the medical records of 648 consecutive patients (648 eyes) undergoing PKP between January 2003 and December 2007 were retrospectively reviewed. Patients who subsequently sustained microbial keratitis were enrolled and analyzed for potential risk factors, clinical manifestations, microbiological profiles, complications, graft survival, and final visual outcome. A total number of 42 corneal graft infections (6.5%) were recruited. Mean interval between corneal transplantation and graft infection was 12 ± 9.5 months. Potential risk factors included suture-related problems (31.0%), lid abnormalities (23.8%), persistent epithelial defect (23.8%), contact lens use (14.3%), dry eye (11.9%), and prior rejection episodes (4.8%). Lesions were discovered mostly at the donor-recipient junction ([DRJ] 45.2%). Positive cultures were identified in all of the morbid eyes, of which Pseudomonas aeruginosa was the most common pathogen (38.1%). Despite mandatory hospitalization and topical fortified antibiotics management, complications ensued such as graft failure (71.4%), hypopyon (21.4%), corneal perforation (14.3%), wound dehiscence (11.9%), and endophthalmitis (4.8%). The visual outcome was dismal that graft clarity was achieved in only 12 eyes (28.6%), and that final visual acuity deteriorated to less than 20/200 in 28 eyes (66.7%). In conclusion, microbial keratitis following PKP is a devastating event that severely impairs graft survival rate and postoperative visual outcome which usually occur within the first postoperative year. The incidence of post-PKP microbial keratitis has generally decreased in recent years whilst P. aeroginosa prevails as the leading cause of graft infection in our hospital. Close follow-up by ophthalmologists and elevated self-awareness of patients for at least one year are always encouraged to prevent late-onset infection.
Insights
Microbial keratitis after corneal transplants (PKP) is a serious complication, often caused by Pseudomonas aeruginosa. Early detection and patient awareness are crucial for better outcomes and graft survival.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Transplantation Surgery
Background:
- Microbial keratitis is a significant complication following penetrating keratoplasty (PKP).
- Understanding the clinical and microbiological profiles is essential for managing post-PKP infections.
Purpose of the Study:
- To investigate the clinical and microbiological characteristics of microbial keratitis after PKP.
- To identify risk factors, complications, and outcomes of post-PKP microbial keratitis.
Main Methods:
- Retrospective review of 648 patients undergoing PKP.
- Analysis of 42 cases of microbial keratitis for risk factors, clinical presentation, microbiology, and outcomes.
Main Results:
- The incidence of post-PKP microbial keratitis was 6.5%, with a mean interval of 12 months post-transplant.
- Common risk factors included suture issues, lid abnormalities, and persistent epithelial defects.
- Pseudomonas aeruginosa was the most frequent pathogen (38.1%), and graft failure occurred in 71.4%.
Conclusions:
- Microbial keratitis post-PKP is a devastating complication impacting graft survival and visual outcomes, often occurring within the first year.
- Despite treatment, severe complications like graft failure are common.
- Close ophthalmologist follow-up and patient awareness are vital for preventing late-onset infections.
