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Published on: May 12, 2020
Post penetrating keratoplasty infectious keratitis: Clinico-microbiological profile and predictors of outcome
Abhishek Dave1, Sanil Sawant1, Manisha Acharya1
1Cornea & Refractive Surgery Services, 75838Dr Shroff's Charity Eye Hospital, New Delhi, India.
Purpose:
To study the clinico-microbiological profile, outcomes and prognostic factors of post penetrating keratoplasty (PKP) infectious keratitis.
Methods:
Retrospective review of medical records of 78 patients with post PKP infectious keratitis presenting between January 2014 and December 2018. Demographic, clinical and microbiological profile was documented and predictors of treatment and graft success were evaluated using univariate and subsequent multivariate logistic regression analysis.
Results:
Mean age of patients was 52.17 ± 15.51 years and mean infiltrate size was 19.39 ± 19.68 mm2. Mean duration of presentation with infection post PKP was 11.66 ± 10.65 months. Culture positivity was seen in 64 eyes (82.05%). Bacterial growth was observed in 47 eyes (60.25%), fungal growth in 17 (21.79%) and no microbiological growth in 14 eyes (17.94%). At 3 months the visual acuity (VA) improved in 37 eyes (47.44%), did not change in 27 (34.62%) and deteriorated in 14 (17.95%). Graft failure was noted in 53 eyes (73.08%). Surgical intervention was needed in 47 (60.25%) eyes of which most common was therapeutic PKP in 32 eyes (41.02%). Treatment failure was noted with fungal infection (p = 0.05), poorer vision at presentation (p = 0.02), larger infiltrate area (p = 0.002) and graft infection developing before 1 year (p = 0.02). Graft failure was noted with associated endophthalmitis (p = 0.02), poorer VA at presentation (p = 0.01) and larger infiltrate area (p = 0.02).
Conclusion:
Post PKP infectious keratitis is a sight threatening ocular condition. It is associated with high incidence of graft failure and frequently requires surgical intervention. Fungal etiology, larger infiltrate size, poorer vision at presentation and associated endophthalmitis carries a poorer prognosis.
Insights
Post penetrating keratoplasty (PKP) infectious keratitis is a serious condition leading to high graft failure rates and often requiring surgery. Fungal infections, large infiltrates, and poor initial vision worsen the prognosis for infectious keratitis after PKP.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Transplant Surgery
Background:
- Post-keratoplasty infectious keratitis is a significant complication following corneal transplantation.
- Understanding its clinical and microbiological characteristics is crucial for effective management.
Purpose of the Study:
- To investigate the clinico-microbiological profile of infectious keratitis after penetrating keratoplasty (PKP).
- To identify outcomes and prognostic factors associated with treatment and graft success in post-PKP infectious keratitis.
Main Methods:
- Retrospective review of 78 patients diagnosed with post-PKP infectious keratitis between January 2014 and December 2018.
- Analysis of demographic, clinical, and microbiological data.
- Logistic regression analysis to evaluate predictors of treatment and graft success.
Main Results:
- The mean age was 52.17 years; mean infiltrate size was 19.39 mm².
- Culture positivity was 82.05%, with bacterial (60.25%) and fungal (21.79%) infections being common.
- Graft failure occurred in 73.08% of cases, often requiring surgical intervention (60.25%).
- Fungal etiology, larger infiltrate size, poorer initial visual acuity, and graft infection before one year were associated with treatment failure.
- Endophthalmitis, poorer initial visual acuity, and larger infiltrate size predicted graft failure.
Conclusions:
- Post-PKP infectious keratitis is a sight-threatening condition with a high incidence of graft failure and need for surgery.
- Fungal etiology, larger infiltrate size, poor initial vision, and endophthalmitis are associated with a poorer prognosis.
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