Infectious keratitis after keratoplasty

Dávila, José

doi:10.1097/icu.0000000000000269

Cited by 36 publications

(30 citation statements)

References 61 publications

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“…[ 6 , 8 , 10 , 15 ] Explanations for the poor prognosis after receiving appropriate antimicrobial treatment in our study are because of postinfection scarring and opacity, and the severe inflammation as well as wound dehiscence would lead to decompensation of graft endothelium. [ 28 ] In our previous report, [ 7 ] the graft survival rate (30.8%) was similar to the current result. However, visual acuity better than 20/200 was resumed in the total 12 clear grafts in the current series while visual acuity worse than 20/200 was noted in 3 of the 12 patients with clear grafts in previous series.…”

Section: Discussionsupporting

confidence: 90%

Shifting trends in microbial keratitis following penetrating keratoplasty in Taiwan

et al. 2017

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To investigate the clinical and microbiological profiles from microbial keratitis following penetrating keratoplasty (PKP) in a tertiary referral center in Taiwan, the medical records of 648 consecutive patients (648 eyes) undergoing PKP between January 2003 and December 2007 were retrospectively reviewed. Patients who subsequently sustained microbial keratitis were enrolled and analyzed for potential risk factors, clinical manifestations, microbiological profiles, complications, graft survival, and final visual outcome. A total number of 42 corneal graft infections (6.5%) were recruited. Mean interval between corneal transplantation and graft infection was 12 ± 9.5 months. Potential risk factors included suture-related problems (31.0%), lid abnormalities (23.8%), persistent epithelial defect (23.8%), contact lens use (14.3%), dry eye (11.9%), and prior rejection episodes (4.8%). Lesions were discovered mostly at the donor-recipient junction ([DRJ] 45.2%). Positive cultures were identified in all of the morbid eyes, of which Pseudomonas aeruginosa was the most common pathogen (38.1%). Despite mandatory hospitalization and topical fortified antibiotics management, complications ensued such as graft failure (71.4%), hypopyon (21.4%), corneal perforation (14.3%), wound dehiscence (11.9%), and endophthalmitis (4.8%). The visual outcome was dismal that graft clarity was achieved in only 12 eyes (28.6%), and that final visual acuity deteriorated to less than 20/200 in 28 eyes (66.7%). In conclusion, microbial keratitis following PKP is a devastating event that severely impairs graft survival rate and postoperative visual outcome which usually occur within the first postoperative year. The incidence of post-PKP microbial keratitis has generally decreased in recent years whilst P. aeroginosa prevails as the leading cause of graft infection in our hospital. Close follow-up by ophthalmologists and elevated self-awareness of patients for at least one year are always encouraged to prevent late-onset infection.

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Section: Discussionsupporting

confidence: 90%

Shifting trends in microbial keratitis following penetrating keratoplasty in Taiwan

et al. 2017

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“… 7 , 8 , 12 , 13 In developed countries, Candida albicans is the most frequently isolated fungus in corneal infections; however, the prevalence of Candida parapsilosis is increasing. 9 , 14 New keratoplasty techniques may reduce the rate of postoperative infectious keratitis but retrospective data regarding the rate of keratitis following lamellar surgeries are still limited. 9 …”

Section: Discussionmentioning

confidence: 99%

“… 9 , 14 New keratoplasty techniques may reduce the rate of postoperative infectious keratitis but retrospective data regarding the rate of keratitis following lamellar surgeries are still limited. 9 …”

Section: Discussionmentioning

confidence: 99%

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Candida parapsilosis Infection After Crescentic Lamellar Wedge Resection in Pellucid Marginal Degeneration

Özbek-Uzman

Burcu

Yalnız-Akkaya

et al. 2018

tjo

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Infectious keratitis after corneal lamellar surgery is a rare complication. In this report, we present unexpected complications after crescentic lamellar wedge resection (CLWR) and their treatment in a patient with pellucid marginal degeneration. A 42-year-old male patient developed fungal keratitis due to Candida parapsilosis in the late postoperative period after CLWR. Infection was controlled with medical treatment. However, recurrent intraocular infections and cataract formation occurred, probably due to capsular damage and inoculation of microorganisms into the crystalline lens during antifungal drug injection. Lensectomy was performed due to cataract progression and recurrence of the infection when treatment was discontinued. Amphotericin B was administered to the anterior chamber at the end of the operation. Four months later, an intraocular lens was implanted and corneal cross-linking treatment was performed. At the last visit, visual acuity reached 9/10. This case shows that good visual acuity can be achieved with appropriate treatment of fungal keratitis and all associated complications after CLWR.

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“…Concomitant ICK presented with advanced disease and has been associated with significant stromal loss and subsequent scarring. 133,25,30,83 E. ORGANISMS When ICK is suspected, the etiological pathogen can be determined through culturing of the infiltrate. Superficial corneal scrapings are often unsuccessful, as they may not reach the depth of the lesions and a corneal biopsy may be required to confirm the diagnosis.…”

Section: 83mentioning

confidence: 99%

Infectious crystalline keratopathy

Porter

Lee

Jun

2018

Survey of Ophthalmology

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Infectious crystalline keratopathy was first reported by Gorovoy and colleagues in 1983 when they identified bacteria colonizing a cornea after a penetrating keratoplasty. Subsequent cases have elaborated on the organisms responsible and the management outcomes. Patients present with a white or gray branching opacity originating from an epithelial defect, commonly after a penetrating keratoplasty. Local immunosuppression contributes to the quiescent nature and the limited inflammatory response associated with infectious crystalline keratopathy. Diagnosis of the infective pathogens may be difficult, with a corneal scraping often being too superficial to obtain an adequate specimen. A biofilm is present that advantages microorganism survival, reduces antibiotic bioavailability, and inhibits diagnostic microbial detection. Treatment begins with topical antimicrobials, initially broad spectrum and then targeted to microorganism sensitivity. Adjunctive therapies to enhance the efficacy of treatment include disruption of the microorganism biofilm by laser, intrastromal antibiotics, and keratectomy. In recalcitrant cases, or where corneal scarring ensues, corneal transplantation is required.

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Infectious keratitis after keratoplasty

Cited by 36 publications

References 61 publications

Shifting trends in microbial keratitis following penetrating keratoplasty in Taiwan

Shifting trends in microbial keratitis following penetrating keratoplasty in Taiwan

Candida parapsilosis Infection After Crescentic Lamellar Wedge Resection in Pellucid Marginal Degeneration

Infectious crystalline keratopathy

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