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Published on: June 12, 2012
Post-Keratoplasty Microbial Keratitis in the Era of Lamellar Transplants-A Comprehensive Review
Joanna Przybek-Skrzypecka1,2, Katarzyna Samelska1,2, Agata Joanna Ordon2,3
1Department of Ophthalmology, Medical University of Warsaw, Marszałkowska 24/26, 00-576 Warsaw, Poland.
Abstract:
Microbial keratitis in a post-transplant cornea should be considered a distinct entity from microbial keratitis in a non-transplant cornea. Firstly, the use of immunosuppressive treatments and sutures in corneal transplants changes the etiology of keratitis. Secondly, corneal transplant has an impact on corneal biomechanics and structure, which facilitates the spread of infection. Finally, the emergence of lamellar transplants has introduced a new form of keratitis known as interface keratitis. Given these factors, there is a clear need to update our understanding of and management strategies for microbial keratitis following corneal transplantation, especially in the era of lamellar transplants. To address this, a comprehensive review is provided, covering the incidence, risk factors, causes, and timing of microbial keratitis, as well as both clinical and surgical management approaches for its treatment in cases of penetrating and lamellar corneal transplants.
Insights
Microbial keratitis after corneal transplants is unique due to immunosuppression and structural changes. This review updates understanding and management for both penetrating and lamellar transplants, including interface keratitis.
Area of Science:
- Ophthalmology
- Microbiology
- Transplantation Immunology
Background:
- Microbial keratitis in transplanted corneas differs significantly from non-transplant cases.
- Immunosuppression, sutures, and altered corneal biomechanics in transplants promote infection.
- Lamellar keratoplasty introduced interface keratitis, a novel clinical challenge.
Purpose of the Study:
- To provide a comprehensive review of microbial keratitis in corneal transplant recipients.
- To highlight the distinct characteristics and management of post-keratoplasty microbial keratitis.
- To update clinical and surgical strategies, particularly concerning lamellar transplants.
Main Methods:
- Systematic literature review.
- Analysis of incidence, risk factors, etiology, and timing of microbial keratitis.
- Evaluation of clinical and surgical management options for penetrating and lamellar grafts.
Main Results:
- Corneal transplant recipients face unique microbial keratitis profiles.
- Interface keratitis is a specific concern in lamellar keratoplasty.
- Management strategies must account for transplant type and immunosuppression.
Conclusions:
- Microbial keratitis post-corneal transplant requires distinct diagnostic and therapeutic approaches.
- Updated understanding is crucial for effective management, especially with evolving lamellar techniques.
- This review offers a framework for addressing this challenging clinical entity.
