Reverse endothelial scraping technique for refractory deep infectious keratitis: Novel surgical technique and outcome...

Area of Science:

• Ophthalmology
• Microbiology
• Surgical Techniques

Background:

• Deep stromal and endothelial infectious plaques are challenging to manage with conventional therapies.
• Infectious keratitis unresponsive to medical treatment requires effective diagnostic and therapeutic interventions.

Purpose of the Study:

• To describe and evaluate the novel corneal Reverse Endothelial Scraping Technique (REST) for diagnosing and managing deep stromal and endothelial infectious plaques.
• To assess the efficacy of REST in guiding targeted microbiological therapy and improving patient outcomes.

Main Methods:

• A retrospective, interventional study involving 16 patients with infectious deep stromal endothelial infiltrates.
• REST involved using a reverse Sinskey hook to debulk and scrape endothelial plaque via paracentesis for microbiological evaluation.
• Samples were analyzed using Gram's stain, 10% KOH, Giemsa stain, and various culture media; treatment was tailored based on results.

Main Results:

• REST enabled microbiological confirmation in all 16 cases, guiding targeted therapy.
• Fungal etiology was the most common cause (62.5%), followed by bacterial (25%).
• Infection resolution was achieved in 93.75% of cases; 50% achieved a corrected distant visual acuity of 6/18 or better.

Conclusions:

• REST is a novel and effective technique for debulking and scraping infectious endothelial plaques, facilitating targeted therapy.
• This technique can help avoid more invasive procedures like therapeutic keratoplasty.
• A tailored management approach guided by microbiological results from REST improves outcomes in severe infectious keratitis.