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Early postoperative infection following lamellar keratoplasty: a review
Shilpa Das1, Sunita Chaurasia2, Savitri Sharma3
1Cornea Service, Narayana Nethralaya, Bengaluru, Karnataka, India.
Abstract:
With the growing popularity of lamellar keratoplasty for selective replacement of diseased corneal tissue, it is important to understand the risk of developing an infection after the procedure. Although lesser than that postpenetrating keratoplasty, the reports on post lamellar keratoplasty infectious keratitis are not negligible. Trends of acute infections arising within 2 months of surgery are a subject of interest. Most of these infections are reported post Descemet's stripping endothelial keratoplasty with a preponderance of Candida species. A donor to host transmission of infection is not uncommon. Among the Candida cases, about 80% seem to occur due to a donor to host transmission. Infections presenting as or progressing to endophthalmitis lead to a poor visual outcome. Strict aseptic measures and protocols during corneal tissue harvesting, tissue processing, tissue storage and surgery are essential to prevent occurrence of these infections. After the infection has occurred, determining the aetiology and drug susceptibility through microbiological testing is vital. This helps to guide treatment protocols and hence determines final outcome of these cases. Most cases require some form of surgical management for resolution of infection, most often a graft removal and therapeutic keratoplasty. Secondary surgical interventions are performed to restore graft clarity and achieve a good final visual outcome.
Insights
Infectious keratitis after lamellar keratoplasty, particularly Descemet's stripping endothelial keratoplasty, is a risk. Donor-to-host transmission of Candida species is a common cause, necessitating strict aseptic protocols and prompt microbiological testing for effective treatment.
Area of Science:
- Ophthalmology
- Microbiology
- Transplantation
Background:
- Lamellar keratoplasty is increasingly popular for corneal tissue replacement.
- Infectious keratitis is a known complication, though less common than post-penetrating keratoplasty.
- Acute infections within two months post-surgery are a significant concern.
Purpose of the Study:
- To analyze the trends and characteristics of infectious keratitis following lamellar keratoplasty.
- To highlight the role of donor-to-host transmission in post-keratoplasty infections.
- To emphasize the importance of aseptic techniques and microbiological diagnostics.
Main Methods:
- Review of reported cases of infectious keratitis post-lamellar keratoplasty.
- Analysis of infection timing, causative organisms (especially Candida), and transmission routes.
- Evaluation of treatment strategies, including microbiological testing and surgical interventions.
Main Results:
- Descemet's stripping endothelial keratoplasty has a notable incidence of infectious keratitis.
- Candida species are frequently implicated, with ~80% of cases linked to donor-to-host transmission.
- Infections progressing to endophthalmitis result in poor visual outcomes.
Conclusions:
- Strict aseptic measures throughout the corneal graft process are crucial for preventing infections.
- Prompt microbiological identification of pathogens and drug susceptibility testing are vital for guiding treatment.
- Surgical management, often involving graft removal and therapeutic keratoplasty, is frequently required for infection resolution and visual recovery.
