Infectious interface keratitis after Descemet membrane endothelial keratoplasty

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.