Related Experiment Video
Updated: Jan 5, 2026
Full-Field Optical Coherence Microscopy for Histology-Like Analysis of Stromal Features in Corneal Grafts
Published on: October 21, 2022
Therapeutic penetrating keratoplasty for microbial keratitis in Taiwan from 2001 to 2014
Teck Boon Tew1, Hsiao-Sang Chu2, Yu-Chih Hou2
1Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
Purpose:
To study the surgical outcome of therapeutic penetrating keratoplasty (TPK) for medically uncontrolled microbial keratitis at a tertiary hospital in Taiwan over a 14-year period.
Methods:
This is a retrospective case series study. Patients who underwent TPK at National Taiwan University Hospital in 2001-2014 were included. Patients were divided into 3 diagnostic groups: bacterial keratitis, fungal keratitis, and acanthamoeba keratitis. Each of the following criteria was evaluated: graft clarity at 1 month and 1 year postoperatively, cure of the disease, and anatomical success rate.
Results:
A total of 107 TPKs were included. TPK eradicated the infection in 57/62 (91.9%) of bacterial keratitis, 33/41 (80.5%) of fungal keratitis, and 9/10 (90.0%) of acanthamoeba keratitis. 22/57 grafts (38.6%) of bacterial keratitis, 22/38 grafts (57.9%) of fungal keratitis, and 5/10 grafts (50.0%) of acanthamoeba keratitis remained clear at 1 year postoperatively. The 1-year graft survival rate did not significantly differ among these 3 groups. The leading causes of graft failure were late endothelial decompensation and graft reinfection. A higher percentage of graft clarity was achieved in grafts <8.5 mm in diameter than in larger grafts (55.4% vs. 31.4%, P = 0.027). Of the 14 patients with endophthalmitis at the time of TPK, the infection was successfully treated in 13 patients except 1 patient required evisceration.
Conclusion:
TPK is valuable in the management of medically uncontrolled microbial keratitis, although the 1-year graft survival rate is unsatisfactory. TPK combined with intravitreal antibiotics and vitrectomy is also a beneficial treatment strategy for patients with endophthalmitis secondary to microbial keratitis.
Insights
Therapeutic penetrating keratoplasty (TPK) is effective for microbial keratitis, but graft survival rates are suboptimal. Smaller grafts (<8.5 mm) showed better clarity, and TPK is beneficial for endophthalmitis.
Area of Science:
- Ophthalmology
- Microbiology
- Surgical Science
Background:
- Microbial keratitis poses a significant threat to vision, often requiring surgical intervention when medical management fails.
- Therapeutic penetrating keratoplasty (TPK) is a critical surgical option for eyes with medically uncontrolled microbial keratitis.
Purpose of the Study:
- To evaluate the surgical outcomes of therapeutic penetrating keratoplasty (TPK) for medically uncontrolled microbial keratitis.
- To analyze graft clarity, disease cure, and anatomical success rates over a 14-year period at a tertiary hospital.
Main Methods:
- A retrospective case series of 107 patients undergoing TPK between 2001 and 2014.
- Patients were categorized into bacterial, fungal, and acanthamoeba keratitis groups.
- Outcomes assessed included graft clarity at 1 month and 1 year, disease cure, and anatomical success.
Main Results:
- TPK demonstrated high infection eradication rates across all keratitis types (80.5%-91.9%).
- One-year graft clarity varied by etiology: bacterial (38.6%), fungal (57.9%), and acanthamoeba (50.0%), with no significant difference in graft survival rates among groups.
- Smaller grafts (<8.5 mm) achieved significantly higher clarity (55.4% vs. 31.4%, P=0.027).
- TPK was successful in 13 of 14 patients with concurrent endophthalmitis.
Conclusions:
- TPK is a valuable surgical procedure for managing medically uncontrolled microbial keratitis, despite suboptimal long-term graft survival.
- Smaller graft size may improve graft clarity post-TPK.
- Combined TPK with intravitreal antibiotics and vitrectomy is a viable strategy for endophthalmitis secondary to microbial keratitis.
