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Corneal Donor Tissue Preparation for Endothelial Keratoplasty
Published on: June 12, 2012
Infectious interface keratitis after Descemet membrane endothelial keratoplasty
Nesrin Tutas Gunaydin1, Burak Tanyıldız1, Baran Kandemir1
1Ophthalmology Department, University of Healty Sciences Dr. Lutf Kırdar Kartal Training and Research Hospital, Istanbul, Turkey.
Purpose:
To evaluate the clinical course and management of infectious interface keratitis after Descemet membrane endothelial keratoplasty.
Methods:
A total of 352 cases that had undergone Descemet membrane endothelial keratoplasty were retrospectively reviewed. Patients with infectious interface keratitis during follow-up were analyzed. The microbiological analyses, time to infection onset, clinical findings, follow-up duration, treatment, and post-treatment corrected distance visual acuity were recorded.
Results:
IIK was detected in eight eyes of eight cases. Three fungal and three bacterial pathogens were identified in all cases. All patients received medical treatment according to culture sensitivity. Antifungal treatment was initiated in two cases with no growth on culture, with a preliminary diagnosis of fungal interface keratitis. Intrastromal antifungal injections were performed in all patients with fungal infections. The median time to infection onset was 164 days (range: 2-282 days). The postoperative infectious interface keratitis developed in the early period in two cases. The mean follow-up duration was 13.4 ± 6.2 months (range: 6-26 months). Re-Descemet membrane endothelial keratoplasty was performed in two patients (25%) and therapeutic penetrating keratoplasty in four patients (50%) who did not recover with medical treatment. The final corrected distance visual acuity was 20/40 or better in five patients (62.5%).
Conclusion:
The diagnosis and treatment of infectious interface keratitis following Descemet membrane endothelial keratoplasty are challenging. Early surgical intervention should be preferred in the absence of response to medical treatment. Better graft survival and visual acuity can be achieved with therapeutic penetrating keratoplasty and re-Descemet membrane endothelial keratoplasty in patients with infectious interface keratitis.
Insights
Infectious interface keratitis (IIK) after Descemet membrane endothelial keratoplasty (DMEK) is challenging. Early surgical intervention improves graft survival and visual acuity in patients unresponsive to medical treatment.
Area of Science:
- Ophthalmology
- Microbiology
- Surgical Science
Background:
- Descemet membrane endothelial keratoplasty (DMEK) is a common procedure for endothelial dysfunction.
- Infectious interface keratitis (IIK) is a rare but serious complication following DMEK.
- Prompt diagnosis and management are crucial for visual outcomes.
Purpose of the Study:
- To evaluate the clinical course and management strategies for infectious interface keratitis (IIK) after Descemet membrane endothelial keratoplasty (DMEK).
Main Methods:
- Retrospective review of 352 DMEK cases.
- Analysis of patients diagnosed with IIK, including microbiological data, onset time, clinical presentation, treatment, and visual outcomes.
- Recorded follow-up duration and interventions such as medical therapy, intrastromal injections, re-DMEK, and penetrating keratoplasty.
Main Results:
- IIK occurred in 8 eyes (2.27%) of 8 patients.
- Common pathogens included three fungal and three bacterial species.
- Median time to infection onset was 164 days; two cases presented early.
- 50% of patients required therapeutic penetrating keratoplasty, and 25% underwent re-DMEK.
- Final corrected distance visual acuity was 20/40 or better in 62.5% of cases.
Conclusions:
- Diagnosing and managing IIK post-DMEK presents significant challenges.
- Early surgical intervention is recommended for cases unresponsive to medical treatment.
- Therapeutic penetrating keratoplasty and re-DMEK can enhance graft survival and visual acuity in IIK patients.
