Evolving Trends and Risk Factors in Infectious Keratitis after Keratoplasty: A 22-Year Multi-Institutional Analysis

Area of Science:

• Ophthalmology
• Microbiology
• Epidemiology

Background:

• Infectious keratitis is a significant complication following keratoplasty.
• Understanding incidence, risk factors, and microbial profiles is crucial for patient outcomes.

Purpose of the Study:

• To analyze the incidence, risk factors, and microbial profiles of infectious keratitis after penetrating keratoplasty, anterior lamellar keratoplasty, and endothelial keratoplasty.
• To identify trends and significant risk factors associated with post-keratoplasty infectious keratitis.

Main Methods:

• Retrospective multi-institutional study using the Chang Gung Research Database (Taiwan, 2001-2022).
• Identified keratoplasty cases and confirmed infectious keratitis via positive cultures.
• Logistic regression analysis to determine risk factors.

Main Results:

• Overall incidence of infectious keratitis increased from 7.7% (2001-2011) to 14.0% (2012-2022).
• Anterior lamellar keratoplasty had the highest incidence, followed by penetrating and endothelial keratoplasty.
• Significant risk factors included older age, ocular surface diseases, and anterior lamellar keratoplasty. Staphylococcus species, Pseudomonas aeruginosa, Fusarium, Candida, CMV, and EBV were identified pathogens.

Conclusions:

• The incidence of infectious keratitis post-keratoplasty has significantly increased.
• Anterior lamellar keratoplasty poses a higher risk compared to other keratoplasty types.
• Identifying risk factors is vital for improving clinical decision-making and postoperative care.