Corneal ulcers in corneal transplants

Twenty-nine eyes, representing an infection rate of 4.9%, developed corneal ulcers following corneal transplant surgery; 26 with available data are presented. All occurred in the graft or at the wound margin. The median postoperative time to ulcer development was 5.5 months. All eyes were on topical steroids when the ulcer developed. Other associated factors were: loose sutures, bandage lenses and eyes grafted for herpes simplex keratitis. Ninety percent of the ulcers had one or more of these factors. Positive cultures for organisms were obtained in 75% and positive gram stain in 68% of the ulcers. Nine genera of bacteria were cultured; S. epidermidis, S. pneumoniae, P. aeruginosa and Corynebacterium were the most common organisms. Ninety-five percent of the bacteria tested were sensitive to gentamicin. Visual reduction occurred in 46% of the cases overall; herpetic corneas had an 88% incidence of visual loss.