A comparative, retrospective, observational study of the clinical and microbiological profiles of post-penetrating keratoplasty keratitis

Abstract

Infectious keratitis after penetrating keratoplasty (PK) is a devastating condition that may result in graft failure and poor visual outcome. In this study, we retrospectively reviewed the medical records of patients who underwent PK between 2009 and 2014, and recorded those who developed infectious keratitis. We compared the predisposing factors and organisms isolated to those identified in our previous study, conducted between 1989 and 1994. The incidence of post-PK infectious keratitis decreased from 11.6% (41 out of 354 cases, 1989–1994) to 6.5% (9 out of 138 cases, 2009–2014). Graft epithelial defect and suture-related problems remained the leading two risk factors of infectious keratitis after PK. Gram-positive and Gram-negative bacterial infection decreased from 58.5% and 46.3% to 11.1% and 22.2%, respectively (P = 0.023 and P = 0.271). In contrast, fungus infection increased from 9.8% to 66.7% (P = 0.001); fungi have become the major pathogen for post-PK infectious keratitis. In conclusion, while the incidence of post-PK infectious keratitis has decreased over time, the number and frequency of fungal infections have significantly increased in the recent study period. Clinicians should be aware of the shifting trend in pathogens involved in post-PK infectious keratitis.

Intraoperative Photoactivated Chromophore for Infectious Keratitis–Corneal Cross-Linking (PACK-CXL) During Penetrating Keratoplasty for the Management of Fungal Keratitis in an Immunocompromised Patient

“…In our case, cultures revealed the presence of Purpureocillium lilacinum (Paecilomyces sp. ), a filamentous fungus that comprises an extremely rare cause of fungal keratitis [1]. Moreover, due to the previous history of ocular irradiation, the eye of our case was immunocompromised, which could have contributed to the inadequate therapeutic response to the topical and systemic antifungal treatment employed.…”

“…Infectious keratitis constitutes a devastating complication of penetrating keratoplasty (PKP) with a reported incidence ranging from 1.76 to 4.9%. Fungal keratitis incidence has increased considerably from 9.8 to 66.7% of infectious keratitis following PKP, accounting for 4.3% of PKPs overall [1]. Typically, post-PKP fungal keratitis is managed with intensive topical and systemic antifungal therapy including intrastromal or intracameral antifungal injections [1].…”

“…Fungal keratitis incidence has increased considerably from 9.8 to 66.7% of infectious keratitis following PKP, accounting for 4.3% of PKPs overall [1]. Typically, post-PKP fungal keratitis is managed with intensive topical and systemic antifungal therapy including intrastromal or intracameral antifungal injections [1]. Nevertheless, graft viability is often put at risk resulting in graft failure necessitating a repeat keratoplasty or even evisceration in the case of intractable intraocular spreading of the infection.…”

Ultra‐thin, high strength, antibiotic‐eluting sutures for prevention of ophthalmic infection

“…[27][28][29][30][31][32] Incidence of infectious keratitis following penetrating keratoplasty has been reported between 1.76% and 12.1%. 33 Suture-related complications are implicated in 20% to over 50% of these cases, and can have devastating consequences, including poor visual outcomes, re-intervention, and graft failure. [33][34][35][36] Thus, it is particularly important to provide for local antibacterial functionality along with implantation of non-absorbable sutures within the eye.…”

“…33 Suture-related complications are implicated in 20% to over 50% of these cases, and can have devastating consequences, including poor visual outcomes, re-intervention, and graft failure. [33][34][35][36] Thus, it is particularly important to provide for local antibacterial functionality along with implantation of non-absorbable sutures within the eye. Local antibiotic delivery from the suture itself would provide bacterial inhibition at the vulnerable surgical incision and help alleviate concerns of non-compliance with topical antibiotic eye drops, which are often prescribed post-operatively.…”