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Suture abscesses after penetrating keratoplasty
A B Leahey1, R L Avery, J D Gottsch
1Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, Maryland 21205.
Abstract:
Eighteen suture abscesses that developed after penetrating keratoplasty in 15 patients were reviewed. The time from keratoplasty to the diagnosis of an abscess ranged from 1 to 53 months with a mean of 21.5 months. In 13 of the 18 cases, the patient was taking topical steroids at the time of diagnosis. All were culture-proven bacterial ulcers, except for one case that had a positive Gram's stain, but no growth on culture. The organisms cultured were Staphylococcus epidemidis (six eyes), Streptococcus pneumoniae (five eyes), Sta. aureus (four eyes), Str. viridans (two eyes), Klebsiella oxytoca (one eye), Serratia marcescens (one eye), Moraxella sp (one eye), and Escherichia coli (one eye). The offending suture was removed in all cases, and the eyes were treated with topical fortified antibiotics (cefazolin and tobramycin). After treatment, 67% (12 of 18 eyes) had clear grafts, 17% (three of 18 eyes) were scarred, and 16% (three of 19 eyes) had failed grafts. Intensive topical steroid therapy was used when a subsequent graft rejection developed. Retained sutures following corneal transplants can result in sight-threatening infections and should be considered for removal as soon as the wound is well healed.
Insights
Retained sutures after corneal transplants can cause serious bacterial infections, often linked to topical steroid use. Prompt suture removal and antibiotic treatment improve graft clarity in most cases.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Suture abscesses are a potential complication following penetrating keratoplasty (corneal transplant).
- These infections can arise months after surgery, often coinciding with topical steroid use.
Purpose of the Study:
- To review cases of suture abscesses post-penetrating keratoplasty.
- To identify causative organisms, treatment outcomes, and risk factors.
Main Methods:
- Retrospective review of 18 suture abscess cases in 15 patients after penetrating keratoplasty.
- Cultures were performed, and patients were treated with suture removal and fortified topical antibiotics (cefazolin and tobramycin).
Main Results:
- Commonly isolated bacteria included Staphylococcus epidermidis, Streptococcus pneumoniae, and Staphylococcus aureus.
- 13 of 18 patients were using topical steroids at diagnosis.
- 67% of grafts were clear after treatment; 16% failed.
Conclusions:
- Retained sutures are a significant risk factor for sight-threatening infections after corneal transplantation.
- Early suture removal and appropriate antibiotic therapy are crucial for managing these infections.
- Topical steroid use may increase the risk of suture abscess development.