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Current Challenges and Long-Term Outcomes in Corneal Transplantation in Infectious Keratitis-A Systematic Review.
Ancuța-Georgiana Onofrei1,2, Alina Gabriela Gheorghe3,4, Ana Maria Dascalu1,4,5
1Doctoral School, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Journal of Clinical Medicine
|January 28, 2026
Summary
Therapeutic keratoplasty preserves the globe in severe microbial keratitis, but visual outcomes are often limited. Factors like infection type and graft size influence success, necessitating further research for improved functional results.
Area of Science:
- Ophthalmology
- Microbiology
- Surgical Science
Background:
- Infectious keratitis is a leading cause of global blindness.
- Therapeutic keratoplasty is often required for advanced cases despite antimicrobial therapies.
Purpose of the Study:
- To systematically review therapeutic keratoplasty outcomes for microbial keratitis.
- To identify factors affecting anatomical success, graft survival, and visual rehabilitation.
Main Methods:
- Systematic review adhering to PRISMA guidelines (2000-2025).
- Inclusion of studies with ≥10 eyes and ≥6 months follow-up.
- Extraction of data on infection control, graft clarity, visual acuity, and complications.
Main Results:
- Analysis of 14 studies (1527 eyes); 89% underwent TPK, DALK used selectively.
- Infection control (69-100%), globe preservation (85-100%). Bacterial keratitis showed better outcomes than fungal/Acanthamoeba.
- Larger grafts and deep stromal involvement increased complications; DALK improved graft survival when endothelium was spared.
Conclusions:
- Therapeutic keratoplasty effectively preserves the globe in advanced microbial keratitis.
- Functional outcomes remain limited, influenced by disease severity and surgical timing.
- Further studies are needed to optimize surgical indications and postoperative management.
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