Endophthalmitis After Descemet Stripping Endothelial Keratoplasty With Concave-Oriented Dislocation on Slit-Lamp Optical Coherence Topography

Kaiura, Terry L.; Ritterband, David C.; Koplin, Richard S.; Shih, Carolyn; Palmierto, Pat M; Seedor, John A.

doi:10.1097/ico.0b013e3181a325c1

Cited by 16 publications

(12 citation statements)

References 7 publications

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“…[22464748495051] They were managed either medically or by PKP. In this series, in early period, one interface fungal keratitis with Candida , and one fulminant endophthalmitis occurred with B. cereus for which evisceration was required on the 5 th day.…”

Section: Discussionmentioning

confidence: 99%

“…The infection following DSEK procedure, either in the form of interface keratitis and endophthalmitis in early postoperative period, or delayed keratitis after 3 months is always serious and has already been reported in literature. [ 22 46 47 48 49 50 51 ] They were managed either medically or by PKP. In this series, in early period, one interface fungal keratitis with Candida , and one fulminant endophthalmitis occurred with B. cereus for which evisceration was required on the 5 th day.…”

Section: Discussionmentioning

confidence: 99%

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Complications and management in Descemet′s stripping endothelial keratoplasty: Analysis of consecutive 430 cases

Basak

2014

Indian J Ophthalmol

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Purpose:To analyze the complications and their managements in Descemet's stripping endothelial keratoplasty (DSEK) in consecutive 430 cases by single surgeon in a tertiary eye hospital.Materials and Methods:430 eyes of 366 patients with endothelial dysfunctions scheduled for DSEK, were analyzed retrospectively. In all cases donor dissection was performed manually, and ‘Taco’ insertion and unfolding technique was used. Intra-operative and postoperative complications with their managements and outcomes were reviewed retrospectively. Periodic endothelial cell density was analyzed for each patient till the last visit. Follow-up period was between 3 to 60 months (mean 18.7 months).Results:13 (3.0%) eyes had operative complications during donor dissection and 16 (3.7%) had during recipient procedure. In 7 (1.6%) eyes, donor lenticule was replaced with a new one during the surgery. In early postoperative period, 21 (4.9%) eyes had donor dislocation and 12 (2.8%) eyes had air-induced pupillary block; and they were managed immediately. 2 cases had primary graft failure and in 1 case had postoperative bacterial endophthalmitis requiring evisceration. In late postoperative period, 48 (11.3%) eyes had secondary glaucoma and 14 (3.3%) eyes had late secondary graft failure. Endothelial rejection occurred in 5 (1.2%) cases. Mean endothelial cell loss was 19.7% after 3 months and 54.2% after 5 years. Total graft failure in this series was 31 (7.2%) and in 17 cases re-DSEK was performed successfully.Conclusions:Both operative and postoperative complications do occur in DSEK. Most of these complications can be managed by medical or appropriate surgical means. Some of the complications can be avoided and reduced with experience.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Complications and management in Descemet′s stripping endothelial keratoplasty: Analysis of consecutive 430 cases

Basak

2014

Indian J Ophthalmol

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“…In cases of DSAEK, removal of donor lenticule may lead to intraocular spread of infection resulting in endophthalmitis ( 21 ). However, in the presence of concomitant endophthalmitis, removal of the donor lenticule helps by reducing the microbial load and aids faster resolution ( 150 ). As such, removal of donor lenticule is not recommended unless there is concomitant endophthalmitis.…”

Section: Treatmentmentioning

confidence: 99%

Post-keratoplasty Infectious Keratitis: Epidemiology, Risk Factors, Management, and Outcomes

et al. 2021

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Post-keratoplasty infectious keratitis (PKIK) represents a unique clinical entity that often poses significant diagnostic and therapeutic challenges. It carries a high risk of serious complications such as graft rejection and failure, and less commonly endophthalmitis. Topical corticosteroids are often required to reduce the risk of graft rejection but their use in PKIK may act as a double-edged sword, particularly in fungal infection. The increased uptake in lamellar keratoplasty in the recent years has also led to complications such as graft-host interface infectious keratitis (IIK), which is particularly difficult to manage. The reported incidence of PKIK differs considerably across different countries, with a higher incidence observed in developing countries (9.2–11.9%) than developed countries (0.02–7.9%). Common risk factors for PKIK include the use of topical corticosteroids, suture-related problems, ocular surface diseases and previous corneal infection. PKIK after penetrating keratoplasty or (deep) anterior lamellar keratoplasty is most commonly caused by ocular surface commensals, particularly Gramme-positive bacteria, whereas PKIK after endothelial keratoplasty is usually caused by Candida spp. Empirical broad-spectrum antimicrobial treatment is the mainstay of treatment for both PKIK, though surgical interventions are required in medically refractory cases (during the acute phase) and those affected by visually significant scarring (during the late phase). In this paper, we aim to provide a comprehensive overview on PKIK, encompassing the epidemiology, risk factors, causes, management and outcomes, and to propose a treatment algorithm for systematically managing this challenging condition.

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“…[23][24][25] Most reports describe poor visual and anatomical outcomes. 16,[26][27][28][29][30][31][32][33] Aggressive treatment may be necessary, and the corneal graft may need to be replaced, often with a penetrating keratoplasty (PKP). 34 Early and aggressive surgical intervention for interface fungal keratitis can result in good visual results.…”

Section: Treatmentmentioning

confidence: 99%

Posterior Segment Complications of Endothelial Keratoplasty

Gibbons¹,

Chang²,

Yannuzzi³

2020

International Ophthalmology Clinics

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Endothelial keratoplasty is the most commonly performed type of corneal transplant in the United States, currently accounting for 60% of total grafts. The anterior segment complications are well documented; however, the posterior segment complications may not be as familiar to the anterior segment surgeon. These include endophthalmitis, cystoid macular edema (CME), choroidal detachment, graft dislocation to the posterior segment, and retinal detachment. CME is the most common postoperative retinal complication with a reported incidence of up to 12.5%, which usually responds well to topical therapy. This article will review the incidence, prevention and management of posterior segment complications after endothelial keratoplasty.

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Endophthalmitis After Descemet Stripping Endothelial Keratoplasty With Concave-Oriented Dislocation on Slit-Lamp Optical Coherence Topography

Abstract: Endophthalmitis is a potential complication for any intraocular procedure including DSEK. SL-OCT imaging postoperatively may reveal concave lenticle configuration and subtle anterior chamber fibrin stranding may be early sign of endophthalmitis.

Cited by 16 publications

References 7 publications

Complications and management in Descemet′s stripping endothelial keratoplasty: Analysis of consecutive 430 cases

Complications and management in Descemet′s stripping endothelial keratoplasty: Analysis of consecutive 430 cases

Post-keratoplasty Infectious Keratitis: Epidemiology, Risk Factors, Management, and Outcomes

Posterior Segment Complications of Endothelial Keratoplasty

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