Microbial keratitis and clinical outcomes following penetrating and endothelial keratoplasty

Dohse, Nicolas; Wibbelsman, Turner D.; Rapuano, Sara B.; Hammersmith, K.M.; Nagra, Parveen K.; Rapuano, Christopher J.; Syed, Zeba A.

doi:10.1111/aos.14404

Cited by 22 publications

(39 citation statements)

References 30 publications

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“…ocular surface-related infection or IIK). A large retrospective cohort study of 2,098 keratoplasty performed between 2007 and 2018 in the US observed a PKIK incidence of 5.9% and 1.3% following PKP and EK, respectively ( 24 ). The higher proportion of PKIK occurring in PKP (93%) compared to DALK (6%) and EK (0%) was similarly depicted in a UK study of 1,508 grafts ( 25 ).…”

Section: Epidemiologymentioning

confidence: 99%

“…The higher proportion of PKIK after PKP hinges on a combination of factors, including the indication for surgery, the use of sutures, and the prolonged use of topical corticosteroids. The indications for EK tend to be non-infective causes such as endothelial dystrophy, whereas a wider range of ocular comorbidities indicated for PKP may include IK and repeat (high-risk) grafts ( 24 ). Additionally, the requirement for corneal sutures in PKP, compared to EK, poses substantial risk of IK.…”

Section: Epidemiologymentioning

confidence: 99%

“…As such, the majority of studies have found topical corticosteroids to be the main contributing factor (72.2–100%) for PKIK, primarily attributed to its local immunosuppressive effect ( 12 , 25 , 32 – 34 , 41 , 42 , 47 , 50 ) ( Figure 1A ). A US study observed that 82.6% eyes that developed PKIK were on topical corticosteroid therapy, of which the rates between PKP and EK were comparative at 81.3 and 90.9%, respectively ( 24 ). Constantinou et al ( 30 ) performed a retrospective study evaluating non-suture-related PKIK after PKP between 1998 and 2008 in Australia.…”

Section: Risk Factorsmentioning

confidence: 99%

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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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Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

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

et al. 2021

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“…Bacterial keratitis is the most frequent type of infectious keratitis, mostly associated with the use of contact lenses (Delgado et al, 2008;Álvarez-Feĺix et al, 2010;Eltis, 2011;Bispo et al, 2015). Worldwide, the main etiologic agents of bacterial keratitis are Gram-positive cocci (Staphylococcus aureus, S. epidermidis, Streptococcus pneumoniae, S. pyogenes, S. viridans), followed by Gram-negative bacillus Pseudomonas aeruginosa (Álvarez-Feĺix et al, 2010;Hernańdez-Camarena et al, 2012;Hernandez-Camarena et al, 2015;Di Zazzo et al, 2020;Dohse et al, 2020;Singh et al, 2020). Eye fungal infections or keratomycosis in the cornea are commonly produced by corneal trauma.…”

Section: Introductionmentioning

confidence: 99%

“…and Aspergillus sp. are the most isolated filamentous fungi (Seal and Pleyer, 2007;Vanzzini-Zago et al, 2010;Hernańdez-Camarena et al, 2012;Di Zazzo et al, 2020;Dohse et al, 2020;Singh et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Microbial Warfare on Three Fronts: Mixed Biofilm of Aspergillus fumigatus and Staphylococcus aureus on Primary Cultures of Human Limbo-Corneal Fibroblasts

Ramírez-Granillo

Bautista-Hernández²,

Lucio³

et al. 2021

Front. Cell. Infect. Microbiol.

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BackgroundCoinfections with fungi and bacteria in ocular pathologies are increasing at an alarming rate. Two of the main etiologic agents of infections on the corneal surface, such as Aspergillus fumigatus and Staphylococcus aureus, can form a biofilm. However, mixed fungal–bacterial biofilms are rarely reported in ocular infections. The implementation of cell cultures as a study model related to biofilm microbial keratitis will allow understanding the pathogenesis in the cornea. The cornea maintains a pathogen-free ocular surface in which human limbo-corneal fibroblast cells are part of its cell regeneration process. There are no reports of biofilm formation assays on limbo-corneal fibroblasts, as well as their behavior with a polymicrobial infection.ObjectiveTo determine the capacity of biofilm formation during this fungal–bacterial interaction on primary limbo-corneal fibroblast monolayers.ResultsThe biofilm on the limbo-corneal fibroblast culture was analyzed by assessing biomass production and determining metabolic activity. Furthermore, the mixed biofilm effect on this cell culture was observed with several microscopy techniques. The single and mixed biofilm was higher on the limbo-corneal fibroblast monolayer than on abiotic surfaces. The A. fumigatus biofilm on the human limbo-corneal fibroblast culture showed a considerable decrease compared to the S. aureus biofilm on the limbo-corneal fibroblast monolayer. Moreover, the mixed biofilm had a lower density than that of the single biofilm. Antibiosis between A. fumigatus and S. aureus persisted during the challenge to limbo-corneal fibroblasts, but it seems that the fungus was more effectively inhibited.ConclusionThis is the first report of mixed fungal–bacterial biofilm production and morphological characterization on the limbo-corneal fibroblast monolayer. Three antibiosis behaviors were observed between fungi, bacteria, and limbo-corneal fibroblasts. The mycophagy effect over A. fumigatus by S. aureus was exacerbated on the limbo-corneal fibroblast monolayer. During fungal–bacterial interactions, it appears that limbo-corneal fibroblasts showed some phagocytic activity, demonstrating tripartite relationships during coinfection.

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Ocular emergencies visits after corneal transplantation at a tertiary eye care hospital in Saudi Arabia

et al. 2022

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Purpose: To evaluate the pro le of patients with post-keratoplasty complications and their presentation at an emergency center.Design: Retrospective one-armed cohort study.Methods: Data were evaluated on patients who underwent corneal grafts in 2019 and presented to an emergency unit. Data were collected on patient demographics, presenting symptoms, clinical details, diagnosis at emergency visit, nal diagnosis, best-corrected visual acuity (BCVA) at presentation and at the last follow up after management. Severe visual impairment (SVI) and graft rejection were tested for correlations to other factors.Results: The study sample was comprised of 149 eyes of 124 patients with a mean age of 27.5 years.Keratoconus was indicated for keratoplasty in 94 (75.8%) patients. The main presenting symptoms were pain 57 (38.3%) and red eye in 52 (34.9%) patients. The median interval between emergency visit and keratoplasty was 1.6 years. There were 63 (42.3%) patients who had emergency visits due to suturerelated problems. The rates of SVI and graft rejection at the time of discharge after managing emergencies in eyes with previous keratoplasty were 14.1% (95% CI 8.5; 19.7) and 13.4 (95% CI 7.9; 18.9) respectively. Keratoconus (OR = 22.8) and young age (P<0.001) were negatively associated to SVI after management.Conclusion: Patients with keratoplasty are at high-risk for severe vision loss and should be counselled to seek urgent eye care for early detection and management of sight threatening complications to improve graft survival and vision.

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Microbial keratitis and clinical outcomes following penetrating and endothelial keratoplasty

Cited by 22 publications

References 30 publications

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

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

Microbial Warfare on Three Fronts: Mixed Biofilm of Aspergillus fumigatus and Staphylococcus aureus on Primary Cultures of Human Limbo-Corneal Fibroblasts

Ocular emergencies visits after corneal transplantation at a tertiary eye care hospital in Saudi Arabia

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