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Wang J, Jin X, Jin H, Jin D, Zhang H. Loose suture-related ocular surface inflammation and activation of conjunctiva-associated lymphoid tissue in patients after keratoplasty. Sci Rep 2024; 14:10452. [PMID: 38714796 PMCID: PMC11076635 DOI: 10.1038/s41598-024-61346-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/05/2024] [Indexed: 05/10/2024] Open
Abstract
The purpose of this study is to evaluate loose suture-related inflammation and activation of conjunctiva-associated lymphoid tissue (CALT) in patients after keratoplasty. The patients who were treated with keratoplasty at the First Affiliated Hospital of Harbin Medical University between 2015 and 2022 were recruited into the study. We evaluated the time and location of loose suture development in patients after keratoplasty. In addition, in vivo confocal microscopy was used to evaluate the activation of CALT and the accumulation of inflammatory cells around loose sutures. Meso Scale Discovery assay detection kits were used to evaluate the inflammatory cytokines in the tears of patients before and after the loose suture was removed. In this study, we collected the information from 212 cases (212 eyes) who had PK (126 eyes) and DALK-treated (86 eyes) for corneal transplantation, including 124 males and 88 females, aged 14-84 years old. The average age was 50.65 ± 16.81 years old. Corneal sutures were more prone to loose at 3 months and 6 months after keratoplasty, and the frequent sites were at 5 and 6 o'clock. An increased number of inflammatory cells could be observed around the loose sutures than normal sutures (P < 0.001). In CALT, the density of diffuse lymphocytes (P < 0.001), follicles (P < 0.001), and parafollicular lymphocytes (P < 0.001) were higher and the central reflection of the follicles (P < 0.001) was stronger when suture loosening happened. The levels of inflammatory cytokines such as IL-1β (P = 0.003), IL-8 (P = 0.012), and TNF-α (P < 0.001) were higher in the tears of the patients with loose sutures. The activation of CALT was partly settled after removing the loose sutures. In conclusion, loose sutures after corneal transplantation can lead to increased infiltration of inflammatory cells, activation of CALT, and increased secretion of inflammatory cytokines in the tears of patients. Regular follow-up to identify and solve the problem in time can avoid suture-related complications.
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Affiliation(s)
- Jingrao Wang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Key Laboratory of Basic and Clinical Research of Heilongjiang Province, No. 23 Youzheng Road, Harbin, Heilongjiang Province, 150001, People's Republic of China
| | - Xin Jin
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Key Laboratory of Basic and Clinical Research of Heilongjiang Province, No. 23 Youzheng Road, Harbin, Heilongjiang Province, 150001, People's Republic of China
| | - Hao Jin
- Departments of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Di Jin
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Key Laboratory of Basic and Clinical Research of Heilongjiang Province, No. 23 Youzheng Road, Harbin, Heilongjiang Province, 150001, People's Republic of China
| | - Hong Zhang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Key Laboratory of Basic and Clinical Research of Heilongjiang Province, No. 23 Youzheng Road, Harbin, Heilongjiang Province, 150001, People's Republic of China.
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Przybek-Skrzypecka J, Samelska K, Ordon AJ, Skrzypecki J, Izdebska J, Kołątaj M, Szaflik JP. Post-Keratoplasty Microbial Keratitis in the Era of Lamellar Transplants-A Comprehensive Review. J Clin Med 2024; 13:2326. [PMID: 38673599 PMCID: PMC11051457 DOI: 10.3390/jcm13082326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Microbial keratitis in a post-transplant cornea should be considered a distinct entity from microbial keratitis in a non-transplant cornea. Firstly, the use of immunosuppressive treatments and sutures in corneal transplants changes the etiology of keratitis. Secondly, corneal transplant has an impact on corneal biomechanics and structure, which facilitates the spread of infection. Finally, the emergence of lamellar transplants has introduced a new form of keratitis known as interface keratitis. Given these factors, there is a clear need to update our understanding of and management strategies for microbial keratitis following corneal transplantation, especially in the era of lamellar transplants. To address this, a comprehensive review is provided, covering the incidence, risk factors, causes, and timing of microbial keratitis, as well as both clinical and surgical management approaches for its treatment in cases of penetrating and lamellar corneal transplants.
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Affiliation(s)
- Joanna Przybek-Skrzypecka
- Department of Ophthalmology, Medical University of Warsaw, Marszałkowska 24/26, 00-576 Warsaw, Poland; (K.S.); (J.I.); (J.P.S.)
- SPKSO Ophthalmic University Hospital in Warsaw, 00-576 Warsaw, Poland; (A.J.O.); (M.K.)
| | - Katarzyna Samelska
- Department of Ophthalmology, Medical University of Warsaw, Marszałkowska 24/26, 00-576 Warsaw, Poland; (K.S.); (J.I.); (J.P.S.)
- SPKSO Ophthalmic University Hospital in Warsaw, 00-576 Warsaw, Poland; (A.J.O.); (M.K.)
| | - Agata Joanna Ordon
- SPKSO Ophthalmic University Hospital in Warsaw, 00-576 Warsaw, Poland; (A.J.O.); (M.K.)
- Department of Binocular Vision Pathophysiology and Strabismus, Medical University of Lodz, 90-647 Lodz, Poland
| | - Janusz Skrzypecki
- Department of Experimental Physiology and Pathophysiology, Medical University of Warsaw, 00-576 Warsaw, Poland;
| | - Justyna Izdebska
- Department of Ophthalmology, Medical University of Warsaw, Marszałkowska 24/26, 00-576 Warsaw, Poland; (K.S.); (J.I.); (J.P.S.)
- SPKSO Ophthalmic University Hospital in Warsaw, 00-576 Warsaw, Poland; (A.J.O.); (M.K.)
| | - Marta Kołątaj
- SPKSO Ophthalmic University Hospital in Warsaw, 00-576 Warsaw, Poland; (A.J.O.); (M.K.)
| | - Jacek P. Szaflik
- Department of Ophthalmology, Medical University of Warsaw, Marszałkowska 24/26, 00-576 Warsaw, Poland; (K.S.); (J.I.); (J.P.S.)
- SPKSO Ophthalmic University Hospital in Warsaw, 00-576 Warsaw, Poland; (A.J.O.); (M.K.)
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Ittah-Cohen I, Knoeri MJ, Bourcier T, Merabet L, Bouheraoua N, Borderie VM. Infectious keratitis following corneal transplantation: A long-term cohort study. Clin Exp Ophthalmol 2024. [PMID: 38267255 DOI: 10.1111/ceo.14354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/26/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND To assess the long-term incidence and risk factors for post-keratoplasty infectious keratitis (IK), associated ocular pathogens, and antibiotic resistance profiles. METHODS Cohort study including 2553 consecutive penetrating, endothelial, and anterior lamellar keratoplasties performed between 1992 and 2020. Medical and microbiological records of patients clinically diagnosed with IK were retrospectively reviewed. MAIN OUTCOME MEASURES cumulative incidence of IK, infectious agent species, and antibiotics resistance profiles. RESULTS The average follow-up time after transplantation was 112 ± 96 months. Eighty-nine IK episodes were recorded; microbiological tests were positive in 55/89 (62%). The cumulated incidence of postoperative IK was 5.50%/10.25% at 10/20 years. The occurrence of at least one episode of IK after transplantation was associated with lower graft survival in the long term (p < 0.0001). Rejection risk (adjusted Hazard Ratio, 2.29) and postoperative epithelial complications (HR, 3.44) were significantly and independently associated with a higher incidence of postoperative IK. Infectious agents included 41 bacteria, 10 HSV, 6 fungi, and 1 Acanthamoeba. The rate of antibiotic resistance was 0% for vancomycin, 13% for fluoroquinolones, 20% for rifamycin, 59% for aminoglycosides, and 73% for ticarcillin. In 41% of cases, patients were under prophylactic topical antibiotics before the infectious episode. Topical antibiotics were significantly associated with increased resistance to penicillin, carbapenems, and aminoglycosides. CONCLUSION IK (mainly bacterial) is a frequent complication of corneal transplantation in the long term. Vancomycin and fluoroquinolones can be considered as first-line treatments. Prolonged postoperative antibiotic preventive treatment is not advisable as it may increase antibiotic resistance.
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Affiliation(s)
- Ian Ittah-Cohen
- Groupe de Recherche Clinique #32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne Université, Hôpital National des 15-20, Paris, France
| | - M Juliette Knoeri
- Groupe de Recherche Clinique #32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne Université, Hôpital National des 15-20, Paris, France
| | - Tristan Bourcier
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
- Gepromed, The Medical Device Hub for Patient Safety, Strasbourg, France
| | - Lilia Merabet
- Laboratory of Biology, Hôpital National des 15-20, Paris, France
| | - Nacim Bouheraoua
- Groupe de Recherche Clinique #32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne Université, Hôpital National des 15-20, Paris, France
| | - Vincent M Borderie
- Groupe de Recherche Clinique #32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne Université, Hôpital National des 15-20, Paris, France
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Ung L, Chodosh J. Urgent unmet needs in the care of bacterial keratitis: An evidence-based synthesis. Ocul Surf 2023; 28:378-400. [PMID: 34461290 PMCID: PMC10721114 DOI: 10.1016/j.jtos.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/21/2022]
Abstract
Bacterial corneal infections, or bacterial keratitis (BK), are ophthalmic emergencies that frequently lead to irreversible visual impairment. Though increasingly recognized as a major cause of global blindness, modern paradigms of evidence-based care in BK have remained at a diagnostic and therapeutic impasse for over half a century. Current standards of management - based on the collection of corneal cultures and the application of broad-spectrum topical antibiotics - are beset by important yet widely underrecognized limitations, including approximately 30% of all patients who will develop moderate to severe vision loss in the affected eye. Though recent advances have involved a more clearly defined role for adjunctive topical corticosteroids, and novel therapies such as corneal crosslinking, overall progress to improve patient and population-based outcomes remains incommensurate to the chronic morbidity caused by this disease. Recognizing that the care of BK is guided by the clinical axiom, "time equals vision", this chapter offers an evidence-based synthesis for the clinical management of these infections, underscoring critical unmet needs in disease prevention, diagnosis, and treatment.
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Affiliation(s)
- Lawson Ung
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
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Boucenna W, Bourges JL. [Penetrating keratoplasty]. J Fr Ophtalmol 2022; 45:543-558. [PMID: 35300875 DOI: 10.1016/j.jfo.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/28/2022]
Abstract
Penetrating keratoplasty is a tissue transplant commonly performed around the world. For over a century, penetrating keratoplasty has been the standard method of treatment for many corneal diseases causing visual impairment. Recently, lamellar anterior keratoplasty (LAK) or lamellar endothelial (LEK) have become preferable options, resulting in fewer complications and faster functional rehabilitation. While penetrating keratoplasty is less frequently indicated, in favor of these lamellar grafts, it has not necessarily become obsolete, and its use remains appropriate for its chosen indications. Functional results are good if the indication for surgery is properly assessed, therapeutic precautions are taken in view of complications, and follow-up aims to improve initial refractive results as needed.
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Affiliation(s)
- W Boucenna
- Service d'ophtalmologie, université de Picardie Jules-Verne, CHU d'Amiens-Picardie, Amiens, France.
| | - J-L Bourges
- Ophtalmopôle de Paris, université de Paris, hôpital Cochin, AP-HP, Paris, France; Unité Insrm 1138, E17, centre de recherche des Cordeliers, Paris, France
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Pagano L, Shah H, Al Ibrahim O, Gadhvi KA, Coco G, Lee JW, Kaye SB, Levis HJ, Hamill KJ, Semeraro F, Romano V. Update on Suture Techniques in Corneal Transplantation: A Systematic Review. J Clin Med 2022; 11:1078. [PMID: 35207352 PMCID: PMC8877912 DOI: 10.3390/jcm11041078] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 02/06/2023] Open
Abstract
Effective suturing remains key to achieving successful outcomes in corneal surgery, especially anterior lamellar keratoplasty and full thickness transplantation. Limitations in the technique may result in complications such as wound leak, infection, or high astigmatism post corneal graft. By using a systematic approach, this study reviews articles and conducts content analysis based on update 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria). The aim of this paper is to summarize the state of the art of corneal suturing techniques for every type of corneal transplant and patient age and also their outcomes regarding astigmatism and complications. Future developments for corneal transplantation will be also discussed. This is important because especially the young surgeon must have knowledge of the implications of every suture performed in order to achieve consistent and predictable post-operative outcomes and also be aware of all the possible complications.
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Affiliation(s)
- Luca Pagano
- St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK; (H.S.); (K.A.G.); (G.C.); (J.W.L.); (S.B.K.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Haider Shah
- St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK; (H.S.); (K.A.G.); (G.C.); (J.W.L.); (S.B.K.)
| | - Omar Al Ibrahim
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, 25121 Brescia, Italy; (O.A.I.); (F.S.); (V.R.)
| | - Kunal A. Gadhvi
- St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK; (H.S.); (K.A.G.); (G.C.); (J.W.L.); (S.B.K.)
| | - Giulia Coco
- St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK; (H.S.); (K.A.G.); (G.C.); (J.W.L.); (S.B.K.)
| | - Jason W. Lee
- St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK; (H.S.); (K.A.G.); (G.C.); (J.W.L.); (S.B.K.)
- School of Medicine, University of Liverpool, Liverpool L69 3BX, UK
| | - Stephen B. Kaye
- St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK; (H.S.); (K.A.G.); (G.C.); (J.W.L.); (S.B.K.)
- Department of Eye and Vision Science, University of Liverpool, Liverpool L69 3BX, UK; (H.J.L.); (K.J.H.)
| | - Hannah J. Levis
- Department of Eye and Vision Science, University of Liverpool, Liverpool L69 3BX, UK; (H.J.L.); (K.J.H.)
| | - Kevin J. Hamill
- Department of Eye and Vision Science, University of Liverpool, Liverpool L69 3BX, UK; (H.J.L.); (K.J.H.)
| | - Francesco Semeraro
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, 25121 Brescia, Italy; (O.A.I.); (F.S.); (V.R.)
| | - Vito Romano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, 25121 Brescia, Italy; (O.A.I.); (F.S.); (V.R.)
- Department of Eye and Vision Science, University of Liverpool, Liverpool L69 3BX, UK; (H.J.L.); (K.J.H.)
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Song A, Deshmukh R, Lin H, Ang M, Mehta JS, Chodosh J, Said DG, Dua HS, Ting DSJ. Post-keratoplasty Infectious Keratitis: Epidemiology, Risk Factors, Management, and Outcomes. Front Med (Lausanne) 2021; 8:707242. [PMID: 34307431 PMCID: PMC8292647 DOI: 10.3389/fmed.2021.707242] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 06/09/2021] [Indexed: 12/26/2022] Open
Abstract
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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Affiliation(s)
- Anna Song
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rashmi Deshmukh
- Department of Ophthalmology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Jodhbir S. Mehta
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - James Chodosh
- Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, United States
| | - Dalia G. Said
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom
| | - Harminder S. Dua
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom
| | - Darren S. J. Ting
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom
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8
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Dohse N, Wibbelsman TD, Rapuano SB, Hammersmith KM, Nagra PK, Rapuano CJ, Syed ZA. Microbial keratitis and clinical outcomes following penetrating and endothelial keratoplasty. Acta Ophthalmol 2020; 98:e895-e900. [PMID: 32190979 DOI: 10.1111/aos.14404] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 02/23/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE The goal of this study was to review the incidence, risk factors and outcomes of microbial keratitis after penetrating keratoplasty (PK) and endothelial keratoplasty (EK). METHODS The electronic medical records at Wills Eye Hospital were queried for cases of microbial keratitis following PK or EK performed between 1 May 2007 and 1 September 2018. Charts were reviewed to obtain demographic data, transplant characteristics, details of microbial keratitis, graft survival and clinical outcomes. RESULTS During the study period, 2098 transplants were performed in 1601 patients. Of these, 1267 (60.4%) were PKs and 831 (39.6%) were EKs. We identified 86 (4.1%) cases of subsequent microbial keratitis. The incidence of microbial keratitis after PK was significantly higher than after EK (5.9% versus 1.3%; p = 0.005). Furthermore, the rate of infection was higher after repeat transplants (either PK or EK) compared to initial keratoplasties (5.5% versus 3.4%; p = 0.02). Twenty-six (32.1%) grafts remained clear at most recent follow-up after microbial keratitis, and the proportion of clear grafts was higher after EK than PK (66.7% versus 27.8%; p = 0.03). CONCLUSION Rates of microbial keratitis were significantly higher after PK compared to EK, and repeat transplantation was a risk factor for microbial keratitis. To the best of our knowledge, there is no prior study in the literature evaluating microbial keratitis rates after PK and EK and comparing outcomes.
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Affiliation(s)
- Nicolas Dohse
- Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USA
| | - Turner D. Wibbelsman
- Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USA
| | - Sara B. Rapuano
- Cornea Service Wills Eye Hospital Philadelphia Pennsylvania USA
| | - Kristin M. Hammersmith
- Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USA
- Cornea Service Wills Eye Hospital Philadelphia Pennsylvania USA
| | - Parveen K. Nagra
- Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USA
- Cornea Service Wills Eye Hospital Philadelphia Pennsylvania USA
| | - Christopher J. Rapuano
- Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USA
- Cornea Service Wills Eye Hospital Philadelphia Pennsylvania USA
| | - Zeba A. Syed
- Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USA
- Cornea Service Wills Eye Hospital Philadelphia Pennsylvania USA
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9
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Griffin B, Walkden A, Okonkwo A, Au L, Brahma A, Carley F. Microbial Keratitis in Corneal Transplants: A 12-Year Analysis. Clin Ophthalmol 2020; 14:3591-3597. [PMID: 33154618 PMCID: PMC7605946 DOI: 10.2147/opth.s275067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/14/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose To investigate the frequencies, trends, and in vitro drug susceptibilities of the causative pathogens in corneal transplant microbial infections in Manchester Royal Eye Hospital. Methods Corneal scrape results recorded by the microbiology service between 2004 and 2015 were extracted from an established database. This microbiological data was matched with a separate database of all corneal transplant procedures performed in our centre over this time period. Patient records were examined to collect specific patient data and to confirm the diagnosis of microbial keratitis. Results A total of 1508 grafts had been performed at our centre in this period. 72 episodes of graft microbial keratitis were identified from 66 eyes that had undergone keratoplasty procedures. Mean age was 56, and 51% of subjects were male. Ninety-three percent of microbial keratitis episodes occurred in penetrating keratoplasty procedures and 6% in deep anterior lamellar keratoplasty procedures. No endothelial grafts presented with infections throughout this time period. Of the 79 organisms identified, 73% were gram positive, 23% gram negative and 4% fungi. With regard to gram-positive organisms, vancomycin and gentamicin showed 100% and 91% susceptibility, respectively. Ofloxacin had a resistance rate of 13.7%. In terms of gram-negative organisms, gentamicin and chloramphenicol showed 100% sensitivity, with cefuroxime showing 69%. Resistance rates were less than 15% in all tested gram-negative antimicrobials. Conclusion This paper describes the largest collection of corneal transplant infections identified within the UK. This finding may aid clinicians in predicting possible causative organisms for microbial keratitis and aid antibiotic choice.
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Affiliation(s)
- Benjamin Griffin
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Andrew Walkden
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,School of Medical Sciences, University of Manchester, Manchester, UK
| | - Arthur Okonkwo
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,School of Medical Sciences, University of Manchester, Manchester, UK
| | - Leon Au
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,School of Medical Sciences, University of Manchester, Manchester, UK
| | - Arun Brahma
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,School of Medical Sciences, University of Manchester, Manchester, UK
| | - Fiona Carley
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,School of Medical Sciences, University of Manchester, Manchester, UK
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Özalp O, Atalay E, Köktaş Z, Yıldırım N. Distribution of Microbial Keratitis After Penetrating Keratoplasty According to Early and Late Postoperative Periods. Turk J Ophthalmol 2020; 50:206-210. [PMID: 32854461 PMCID: PMC7469893 DOI: 10.4274/tjo.galenos.2020.77026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: The aim of this study was to investigate the distribution of microbial agents in the early and late postoperative periods in patients with microbial keratitis (MK) after penetrating keratoplasty (PK). Materials and Methods: The records of 36 patients who were clinically diagnosed as having MK after PK were retrospectively reviewed. Culture results were obtained from microbiology records and the organisms that were produced were noted. A case was deemed as viral keratitis based on the clinical appearance, negative cultures, and response to antiviral treatment. Keratitis development times were evaluated in 2 categories: early (within the first year) and late (after year 1) postoperative period. Mann-Whitney U and Kruskal-Wallis tests were used to compare numerical variables that did not show normal distribution and chi-square test was used to compare categorical variables. Results: The majority of MK cases were of bacterial origin (55.5%, n=20), followed by viral (41.7%, n=15) and fungal (2.8%, n=1). Of the 15 cases of early postoperative MK, 10 were bacterial, 4 were viral, and 1 was fungal; however, among cases of late postoperative MK, 10 were bacterial and 11 were viral. The majority (65%) of early and late bacterial infections were caused by gram-positive strains (most commonly staphylococci). Gram-positive bacteria caused keratitis significantly earlier than gram-negative bacteria (p=0.037). Viral and gram-negative bacterial MK was more frequent in the late postoperative period, but the difference was not statistically significant. Conclusion: In our study, bacterial keratitis was more common in post-keratoplasty MK than viral and fungal keratitis. Gram-positive bacteria were the most common causative agents. The increased incidence of gram-negative bacterial agents and viral keratitis in the late postoperative period can be explained by long-term topical steroid use.
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Affiliation(s)
- Onur Özalp
- Eskişehir Osmangazi University Faculty of Medicine, Department of Ophthalmology, Eskişehir, Turkey
| | - Eray Atalay
- Eskişehir Osmangazi University Faculty of Medicine, Department of Ophthalmology, Eskişehir, Turkey
| | - Zülfiye Köktaş
- Burdur Gölhisar State Hospital, Clinic of Ophthalmology, Burdur, Turkey
| | - Nilgün Yıldırım
- Eskişehir Osmangazi University Faculty of Medicine, Department of Ophthalmology, Eskişehir, Turkey
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Fan X, Hong J, Xiang J, Cheng J, Xu J. Factors predicting long-term changes in refraction after lamellar keratoscleroplasty in children with limbal dermoids. Eye (Lond) 2020; 35:1659-1665. [PMID: 32839554 DOI: 10.1038/s41433-020-01140-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 07/08/2020] [Accepted: 08/12/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The objective of this study is to determine the factors that predict long-term changes in refraction after lamellar keratoscleroplasty in paediatric patients with limbal dermoids. METHODS A retrospective study of 66 children with limbal dermoids who had lamellar keratoscleroplasty correction with more than 1-year follow-up. Univariate and multivariate regression analyses were performed to investigate factors associated with the long term in refractive parameters, including spherical equivalent, astigmatism, and mean keratometry. The change value was defined as the postoperative refractive value minus the preoperative refractive value. The lower the value of changes, the more satisfied the effects on the correction of the preoperative refraction. RESULTS A total of 66 patients (mean surgical age: 3.5 ± 2.1 years) were assessed with at least 1-year follow-up. Amblyopia treatment duration was the only independent factor predicting the long-term changes in spherical equivalent between baseline and last follow-up visit (β = -0.030, P < 0.001). Lesion encroachment on the central and paracentral cornea (β = 0.502, P = 0.024), suture-related complications (β = 1.571, P < 0.001) and graft rejection (β = 0.983, P = 0.035) were significantly correlated with long-term changes in astigmatism. The long-term changes in refraction were not correlated with surgical age, lesion size, lesion depth, steroid-induced high intraocular pressure and changes in mean keratometry. CONCLUSION Suture-related complications and graft rejection should be carefully observed and appropriately treated in order to avoid the possible postoperative increase in astigmatism, especially for patients with lesion encroachment on the central and paracentral cornea. The long-duration amblyopia treatment after surgery appears to have a better correction effect on spherical equivalent in the long term, compared with astigmatism.
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Affiliation(s)
- Xiangyu Fan
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Jiaxu Hong
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.,The Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Jun Xiang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Jingyi Cheng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Jianjiang Xu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China. .,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China. .,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, 200031, China. .,NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China.
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Feizi S, Azari AA. Approaches toward enhancing survival probability following deep anterior lamellar keratoplasty. Ther Adv Ophthalmol 2020; 12:2515841420913014. [PMID: 32232195 PMCID: PMC7092383 DOI: 10.1177/2515841420913014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 02/07/2020] [Indexed: 12/16/2022] Open
Abstract
The greatest advantage of deep anterior lamellar keratoplasty over full-thickness corneal transplantation is the elimination of graft failure caused by endothelial rejection. Despite this advantage, a deep anterior lamellar keratoplasty graft can fail because of several factors, such as complications related to the donor-recipient interface, graft epithelial abnormalities, graft vascularization, stromal graft rejection, and recurrence of herpetic keratitis. Increased deep anterior lamellar keratoplasty graft survival is mainly built upon optimization of the ocular surface to provide a hospitable environment for the graft. Any predisposing factors for graft epithelial abnormalities, corneal neovascularization, and preexisting vernal keratoconjunctivitis should be identified and treated preoperatively. Prompt recognition and appropriate treatment of interface-related complications and stromal graft rejection usually result in good anatomic outcomes, with no detrimental effects on vision.
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Affiliation(s)
- Sepehr Feizi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Labbafinejad Medical Center, 9th Boostan St., Pasdaran Ave., Tehran 16666, Iran
| | - Amir A Azari
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sun JP, Chen WL, Huang JY, Hou YC, Wang IJ, Hu FR. Microbial Keratitis After Penetrating Keratoplasty. Am J Ophthalmol 2017; 178:150-156. [PMID: 28347669 DOI: 10.1016/j.ajo.2017.03.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 03/12/2017] [Accepted: 03/17/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE To report the incidence, microbiological profile, graft survival, and determining factors of microbial keratitis after penetrating keratoplasty (PK). DESIGN Observational case series. METHODS The study involved 51 patients (52 eyes) who were treated at a single tertiary referral center during a 10-year period. Retrospective chart review included medical records of all patients diagnosed with microbial keratitis after penetrating keratoplasty at the National Taiwan University Hospital between January 2000 and December 2009. The main outcome measures were incidence of graft infection, microbial profile, and graft survival status. RESULTS There were 871 PKs performed and 67 episodes in 52 eyes of culture-positive microbial keratitis during the study period. There were 32 infectious episodes (47.8%) in the first year post-PK and 35 episodes (52.2%) after the first year post-PK. Forty-four gram-positive bacterial isolates (57.9%), 17 gram-negative bacterial isolates (22.4%), and 15 fungal isolates (19.7%) were found. Twenty-three (34.3%) grafts remained clear after the infection episode with a mean follow-up of 1127 days (range, 25-3962 days). There was no difference in graft survival rate regarding the original indication of PK or offending pathogen. Suture-related infection was associated with decreased risk of graft failure (P = .02), while the factor associated with increased risk of graft failure was usage of antiglaucoma agents (P = .01). CONCLUSION Infectious keratitis after penetrating keratoplasty leads to a high graft failure rate. Such complications can occur before or after the first year post-PK.
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Affiliation(s)
- Jen-Pin Sun
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Li Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; Center of Corneal Tissue Engineering and Stem Cell Biology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jehn-Yu Huang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Chih Hou
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Jong Wang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Fung-Rong Hu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; Center of Corneal Tissue Engineering and Stem Cell Biology, National Taiwan University Hospital, Taipei, Taiwan.
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Chen HC, Lee CY, Lin HY, Ma DHK, Chen PYF, Hsiao CH, Lin HC, Yeh LK, Tan HY. Shifting trends in microbial keratitis following penetrating keratoplasty in Taiwan. Medicine (Baltimore) 2017; 96:e5864. [PMID: 28151861 PMCID: PMC5293424 DOI: 10.1097/md.0000000000005864] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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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Affiliation(s)
- Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou
| | - Chia-Yi Lee
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua
| | - Hung-Yu Lin
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Optometry, Chung Shan Medical University, Taichung
- Department of Optometry, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - David Hui-Kang Ma
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou
- Department of Chinese Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Phil Yeong-Fong Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan
| | - Ching-Hsi Hsiao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan
| | - Hsin-Chiung Lin
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan
| | - Lung-Kun Yeh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan
| | - Hsin-Yuan Tan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan
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Sung MS, Choi W, You IC, Yoon KC. Factors Affecting Treatment Outcome of Graft Infection Following Penetrating Keratoplasty. KOREAN JOURNAL OF OPHTHALMOLOGY 2015; 29:301-8. [PMID: 26457035 PMCID: PMC4595255 DOI: 10.3341/kjo.2015.29.5.301] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 04/21/2015] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the factors affecting treatment outcome of graft infection following penetrating keratoplasty (PKP). Methods In this retrospective study, 28 patients who underwent PKP between January 2005 and January 2013 and who were diagnosed with graft infection were classified into a treatment success group or a treatment failure group. Demographic and clinical characteristics, as well as the results of the microbiologic investigation, were analyzed and compared. A subsequent binary logistic regression analysis was performed to identify the prognostic factors affecting treatment outcome. Results Graft infection occurred at a mean of 38.29 ± 36.16 months (range, 1 to 96 months) after PKP. Seventeen patients developed bacterial keratitis, and 11 patients developed fungal keratitis. Overall, of the 28 patients, nine (32.1%) were classified in the treatment failure group. Multivariate analysis identified pre-existing graft failure (p = 0.019), interval longer than 72 hours between donor death and PKP (p = 0.010), and fungal infection (p = 0.026) as significant risk factors for treatment failure. Conclusions Pre-existing graft failure, extended interval between donor death and PKP, and fungal infection were important risk factors for treatment failure of graft infection following PKP.
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Affiliation(s)
- Mi Sun Sung
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Won Choi
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - In Cheon You
- Department of Ophthalmology, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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Clinical Outcomes of Corneal Graft Infections Caused by Multi–Drug Resistant Pseudomonas Aeruginosa. Cornea 2014; 33:22-6. [DOI: 10.1097/ico.0000000000000011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Constantinou M, Jhanji V, Vajpayee RB. Clinical and microbiological profile of post-penetrating keratoplasty infectious keratitis in failed and clear grafts. Am J Ophthalmol 2013; 155:233-237.e2. [PMID: 23111174 DOI: 10.1016/j.ajo.2012.07.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 07/21/2012] [Accepted: 07/23/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To comparatively evaluate the clinical and microbiological profiles and treatment outcome of cases with post-penetrating keratoplasty (PK) infectious keratitis in failed and clear grafts. DESIGN Retrospective, matched cohort study. METHODS All cases of infectious keratitis following penetrating keratoplasty admitted to the Royal Victorian Eye and Ear Hospital, Melbourne, between January 1998 and December 2008 were identified through a retrospective medical chart review. Cases without any surface sutures were selected and divided into 2 groups, microbial keratitis with pre-existing graft failure and microbial keratitis in clear graft on presentation. Demographic, clinical, and microbiological profiles of cases in both groups were analyzed and compared. RESULTS Patients in the failed-graft group were older (P = .004) and had an early onset of graft infection (P = .049), compared with patients in the clear-graft group. All patients in the failed-graft group were on long-term corticosteroid drops at the time of presentation (vs 76% in clear-graft group; P = .005). Moraxella sp was more frequently isolated in the failed-graft group (30.4%) compared with the clear-graft group (8%). A higher number of cases in the clear-graft group required surgical intervention in the form of corneal gluing and therapeutic corneal transplantation compared with the failed-graft group (P = .03). CONCLUSIONS Prolonged use of corticosteroid eye drops is a major risk factor for the occurrence of postkeratoplasty infectious keratitis in failed and clear grafts. Infections in failed grafts occur earlier as compared to clear grafts, and indolent organisms like Moraxella are prevalent in patients with failed grafts in Australia.
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Moorthy S, Graue E, Jhanji V, Constantinou M, Vajpayee RB. Microbial keratitis after penetrating keratoplasty: impact of sutures. Am J Ophthalmol 2011; 152:189-194.e2. [PMID: 21624557 DOI: 10.1016/j.ajo.2011.01.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 01/17/2011] [Accepted: 01/19/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the impact of presence or absence of sutures in cases with post-penetrating keratoplasty (PKP) microbial keratitis. DESIGN A 10-year retrospective chart review of post-PKP patients admitted with microbial keratitis at the Royal Victorian Eye and Ear Hospital, Melbourne, between January 1998 and December 2008 was undertaken. METHODS Patients were categorized in 2 groups, "sutures present" and "sutures absent." Main parameters evaluated were clinical and microbiological profile and treatment outcome. RESULTS One hundred and twenty-two episodes of microbial keratitis were noted in 101 patients: 71 (58.2%) with sutures present and 51 (41.8%) with sutures absent. Overall, pseudophakic bullous keratopathy was the most common indication for keratoplasty (P=.92). Ocular surface disorder was the commonest risk factor associated with the occurrence of infection in both groups (P=.17). Infections caused by Moraxella sp. (P=.001) were significantly more common in the "sutures absent" group. Surgical interventions were required for 47 episodes (39%), with corneal gluing performed in significantly higher number of cases in the "sutures absent" group (40% vs 15%; P=.05). Multivariate analyses did not reveal any significant associations. Final mean visual acuity outcome was poorer in the "sutures absent" group (logMAR 2.10 ± 0.92 vs 1.76 ± 0.96; P=.04). CONCLUSIONS Corneal graft infections, in the presence and absence of sutures, share similar indications and risk factors. However, infections caused by indolent microorganisms were more prevalent in grafts without sutures. This group of patients required a higher number of surgical interventions in the form of corneal gluing and the overall visual outcome was poor.
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Hood CT, Lee BJ, Jeng BH. Incidence, occurrence rate, and characteristics of suture-related corneal infections after penetrating keratoplasty. Cornea 2011; 30:624-8. [PMID: 21282987 DOI: 10.1097/ico.0b013e3182041755] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the incidence, occurrence rate, and characteristics of suture-related infections after penetrating keratoplasty (PK). METHODS Patients who underwent PK at our institution between January 1, 2002, and July 1, 2006, were cross-referenced with patients diagnosed with corneal infections between January 1, 2002, and July 1, 2007. All patient charts were reviewed retrospectively for occurrence of suture-related infections, duration of follow-up, and clinical characteristics. RESULTS Of the 487 PKs performed in 412 patients, 22 eyes of 22 patients developed postoperative corneal infections. Of these, 5 eyes were identified as having suture-related graft infections, yielding an occurrence rate of 1.0%. The average follow-up was 3.46 years per PK, yielding an incidence of 2.96 infections per 1000 PK-years. The mean interval from surgery to infection was 8 months (range: 3-23 months). All culprit sutures were in the interpalpebral zone. No patients were using topical antibiotics at the time of infection, and all patients were using topical corticosteroid drops. Cultured organisms included Staphylococcus aureus (3 cases), coagulase-negative Staphylcoccus (1 case), and S. viridans (1 case). In 2 patients with isolated corneal involvement, topical moxifloxacin was initiated, and the patients responded favorably. In 3 patients with corneal infection and an associated hypopyon or endophthalmitis, vitreous biopsy, intravitreal injections of antibiotics, and fortified topical antibiotics were used. One patient required a repeat PK as a result of the infection. Two eyes eventually became phthisical. CONCLUSIONS The rate of suture-related infections after PK may be lower than previously reported. In our patients, suture-related infections all occurred within the first 2 years after surgery, and some of them resulted in significant morbidity, underscoring the importance of patient identification of symptoms and early clinical recognition.
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Van Meter W, Katz DG. Keratoplasty Suturing Techniques. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00123-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Infections after Penetrating Keratoplasty. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00129-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Alfonso EC, Galor A, Miller D. Fungal Keratitis. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00089-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kim M, Oh JY, Kim MK, Han SB, Lee JH, Wee WR. Clinical Manifestation and Predisposing Factors of Infectious Keratitis Following Penetrating Keratoplasty in Korean Patients. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2010. [DOI: 10.3341/jkos.2010.51.4.504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Mijin Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Youn Oh
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Sang Beom Han
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Bundang Seoul National University Hospital, Seongnam, Korea
| | - Jin Hak Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Bundang Seoul National University Hospital, Seongnam, Korea
| | - Won Ryang Wee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
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Postoperative Complications After Primary Adult Optical Penetrating Keratoplasty: Prevalence and Impact on Graft Survival. Cornea 2009; 28:385-94. [DOI: 10.1097/ico.0b013e31818d3aef] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE To describe the incidence and current management of fungal keratitis in the United Kingdom. METHODS Cases were identified prospectively through the British Ophthalmologic Surveillance Unit (BOSU) from December 2003 to November 2005. Questionnaire data were requested at diagnosis and at 6 months follow-up. Inclusion criteria were a positive culture or microsopic proof from a scraping or biopsy, and a normal residence in the United Kingdom. RESULTS Data were available on 39 confirmed cases at diagnosis and 34 cases at follow-up. The minimum average annualised incidence was 0.32 (95% CI, 0.24-0.44) cases per million individuals. In 22 cases (56%), only Candida was isolated and 14 of these (63%) had prior ocular surface disease treated with topical steroid. A filamentary fungus infection was more common in male patients (P=0.02), often following trauma, and the differences in risk factors between types of fungal infection was statistically significant (P<0.001). One case had a mixed yeast and filamentary fungus infection. The most frequent initial topical therapies were amphotericin B (38%) or econazole (28%). In addition, oral fluconazole was used in 11 (31%) patients and oral itraconazole in six (15%). At follow-up, the vision in 15 eyes (44%) was <6/60 including three eyes eviscerated. CONCLUSIONS This study provides data on the minimum incidence of fungal keratitis in the United Kingdom. It provides evidence of frequent delay in diagnosis after presentation to eye departments, inconsistent management, and poor outcome. Issues that can now be addressed.
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Affiliation(s)
- S J Tuft
- Department of Clinical Ophthalmology, Moorfields Eye Hospital NHS Trust, London, UK.
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Persistent epithelial defects and ulcers in repeated corneal transplantation: incidence, causative agents, predisposing factors and treatment outcomes. Graefes Arch Clin Exp Ophthalmol 2008; 246:1139-45. [DOI: 10.1007/s00417-008-0797-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Revised: 01/25/2008] [Accepted: 02/19/2008] [Indexed: 10/22/2022] Open
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Galarreta DJ, Tuft SJ, Ramsay A, Dart JKG. Fungal keratitis in London: microbiological and clinical evaluation. Cornea 2008; 26:1082-6. [PMID: 17893539 DOI: 10.1097/ico.0b013e318142bff3] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To review cases of culture-positive fungal keratitis seen at Moorfields Eye Hospital over a 13-year period to January 2007. METHODS Isolates were identified retrospectively from laboratory reports. The clinical records were reviewed. The fungal type, risk factors for infection, in vitro sensitivity, and clinical outcome were recorded. RESULTS There were 66 isolates from 65 patients (men, 53.8%). Forty (60.6%) of the isolates were subspecies of Candida. The average interval from the onset of keratitis to confirmation of fungal infection was 3.4 weeks (median, 1.0 week; range, 0-16 weeks). Prior ocular surface disease (OSD) or a penetrating keratoplasty (PK) was present in 38 (97.4%) patients with Candida infection, and 29 (74.4%) patients with Candida infection were using topical steroid at the time of diagnosis. The principal risk factors for filamentary fungal infection were trauma (8 cases, 30.8%) or cosmetic contact lens wear (8 cases, 30.8%), with OSD or a prior PK each present in 5 (19.2%) cases. The difference in the proportions of risk factors between the 2 fungal groups was statistically significant (P < 0.000). The visual outcome was similar between groups, and at final review, 27 (41.5%) eyes had a visual acuity of < or = 1/60 and 3 (4.6%) eyes were eviscerated. In vitro sensitivity testing showed full or part sensitivity in 100% of 55 isolates tested against econazole, 87.9% of 58 isolates tested against amphotericin, 75% of 40 isolates tested against itraconazole, and 100% of 20 isolates tested against voriconazole. CONCLUSIONS Candida was the principal isolate, usually from eyes with OSD or a prior PK treated with topical steroids.
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Long-term Outcomes of Photorefractive Keratectomy in Eyes With Previous Epikeratophakia for Keratoconus. Cornea 2007; 26:1200-4. [DOI: 10.1097/ico.0b013e31815654a5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Al-Swailem SA. Graft failure: II. Ocular surface complications. Int Ophthalmol 2007; 28:175-89. [PMID: 17786390 DOI: 10.1007/s10792-007-9127-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 07/11/2007] [Indexed: 12/13/2022]
Abstract
Risk factors for corneal transplantation failure include both immunologic factors, such as graft rejection, corneal neovascularization, and peripheral anterior synechiae, as well as non-immunologic factors, such as ocular surface disorders (OSD) and glaucoma. This review highlights the necessity of having healthy ocular surface epithelia, tears, and eyelids. It presents different types of OSD, their underlying pathology, and their impact on native cornea and corneal grafts. In addition, a range of proposed donor and surgical factors influencing surface integrity following corneal transplant are addressed. Current medical and surgical research, both pre- and post-operative that promise to further improve the outcome of corneal grafts in the context of OSD are discussed.
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Affiliation(s)
- Samar A Al-Swailem
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh 11462, Kingdom of Saudi Arabia.
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Abstract
PURPOSE To determine the predisposing risk factors and analyse the clinical and microbiological profiles of microbial keratitis following corneal transplantation. METHODS A retrospective analysis was done of hospital records of all patients who presented with microbial keratitis in the corneal graft between July 2000 and June 2005 at the Corneal Unit of Royal Victorian Eye and Ear Hospital, Melbourne, Australia. RESULTS Eighty-one episodes of infection were identified in 62 patients over a 5-year period. Thirteen patients had multiple episodes of infection. The mean age of the patients was 70 +/- 16 years (range: 22-92 years). The median time interval between the graft and infection was 17 months (range: 6 days to 385 months). Twenty-two (35%) episodes of primary infection were related to sutures. The associated predisposing risk factors were failed graft (40%), dry eye (18%), Herpes simplex keratitis (8%), and ocular surface disease (8%). Forty-seven (76%) cases were culture positive for bacteria. Ten cases were positive for Herpes simplex virus (HSV) during presentation. CONCLUSION Failed graft is a long-term risk factor for graft infection in addition to ocular surface disease and H. simplex keratitis. All the predisposing risk factors increase the risk of recurrent graft infection.
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Affiliation(s)
- Sujata Das
- Corneal Clinic, Royal Victorian Eye and Ear Hospital, and Centre for Eye Research Australia, Unviersity of Melbourne, Melbourne, Victoria, Australia.
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Wagoner MD, Al-Ghamdi AH, Al-Rajhi AA. Bacterial keratitis after primary pediatric penetrating keratoplasty. Am J Ophthalmol 2007; 143:1045-7. [PMID: 17524776 DOI: 10.1016/j.ajo.2006.12.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Revised: 12/16/2006] [Accepted: 12/19/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the prevalence, microbiological profile, and prognosis for bacterial keratitis after primary pediatric penetrating keratoplasty (PKP). DESIGN Retrospective case series. METHODS Retrospective review of all cases of primary PKP performed in children 12 years of age or younger at the King Khaled Eye Specialist Hospital between January 1, 1990 and December 31, 2005 and inclusion of all postoperative cases of culture-positive, bacterial keratitis. RESULTS Culture-positive bacterial keratitis developed in 35 (17.3%) of 202 primary keratoplasties. Gram-positive organisms were cultured in 91.4% of infected eyes and accounted for 77.6% of isolates. Streptococcus pneumoniae was the most common organism. No eyes achieved a final visual acuity of 20/40 or better, while 65.7% had hand motions or worse. CONCLUSIONS Bacterial keratitis after pediatric keratoplasty is a serious complication that is associated with a high risk of graft failure and poor visual outcome.
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Affiliation(s)
- Michael D Wagoner
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
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Wagoner MD, Al-Swailem SA, Sutphin JE, Zimmerman MB. Bacterial Keratitis after Penetrating Keratoplasty. Ophthalmology 2007; 114:1073-9. [PMID: 17275089 DOI: 10.1016/j.ophtha.2006.10.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Revised: 10/07/2006] [Accepted: 10/10/2006] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To determine the incidence, microbiological profile, graft survival, and factors influencing graft survival after the development of bacterial keratitis after penetrating keratoplasty (PK). DESIGN Retrospective case series. PARTICIPANTS One hundred two patients (102 eyes) treated at a single center during a 5-year period. METHODS Retrospective review of the medical records of every patient treated for culture-positive keratitis between January 1, 1998 and December 31, 2002 who previously had undergone penetrating keratoplasty at the King Khaled Eye Specialist Hospital. MAIN OUTCOME MEASURES Graft survival and visual outcome. RESULTS There were 2103 PKs performed and 102 (4.9%) cases of culture-positive keratitis during the study period. There were 168 bacterial isolates, of which 140 (83.3%) were gram positive, 28 (16.7%) were gram negative, and 1 (0.6%) was acid fast. Only 38 (37.3%) grafts remained clear after a mean follow-up of 985 days (range, 82-2284). The best graft survival was in eyes with PK for keratoconus (83.7%), whereas the poorest grat survival was for previously failed grafts (5.6%). By Kaplan-Meier analysis, there was an immediate steep decline in graft survival to 54.9%, followed by a slow decline to 47.2% by 1 year and 35.8% after 4 years. Factors associated with an increased risk of graft failure were the surgical indication for PK (P<0.001), increasing patient age (P = 0.004), smaller donor (P = 0.001) and recipient (P = 0.0003) graft size, history of previous microbial keratitis (P = 0.02) or endothelial rejection episodes (P = 0.02), and coexisting glaucoma (P = 0.001). The visual outcome was > or =20/40 in only 8 (8.2%) eyes and better than 20/200 in only 21 (21.6%) eyes. CONCLUSION The development of bacterial keratitis after PK is a serious complication that is associated with a high incidence of graft failure and poor visual outcome.
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Affiliation(s)
- Michael D Wagoner
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
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Abstract
Infectious keratitis following corneal transplantation is one of the leading causes of failure of a corneal graft. The incidence of graft infection is variable, with developing countries having a higher incidence. The majority of the graft infections occur within 1 year of the corneal transplantation. Suture-related problems and persistent epithelial defect are the most common risk factors predisposing to graft infection. Pneumococcus species and Staphylococcus aureus have been found to be the commonest microorganisms in the developed world, whereas Staphylococcus epidermidis is the most often detected microorganism in corneal graft infection in the developing world. The early identification of predisposing risk factors in patients and their appropriate management at the earliest may prevent the occurrence of graft infection and might improve graft survival. Visual prognosis in eyes with post-keratoplasty graft infection is poor even after optimal therapy and there is a high rate of graft decompensation.
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Affiliation(s)
- Rasik B Vajpayee
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Yang KS, Lin HC, Ma DHK, Chen HC, Tan HY, Huang SCM, Lin KK, Hsiao CH. Ulcerative Keratitis Caused by Haemophilus Influenzae. Cornea 2006; 25:701-4. [PMID: 17077664 DOI: 10.1097/01.ico.0000208816.02120.4b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the clinical course, treatments, antibiotic sensitivities, and visual outcomes for eyes with ulcerative keratitis caused by Haemophlilus influenzae. METHODS The medical records of 10 patients with culture-proven H. influenzae-associated corneal ulcer in a tertiary referral center in a 5-year period (1998-2003) were retrospectively reviewed. RESULTS The median age was 61 years (range, 2-83 years). The mean follow-up time was 9.4 months (range, 2-31 months). Risk factors such as previous surgeries (5), herpes simplex keratitis (2), leukoma adherens with calcification (1), and exposure keratitis (1) were identified in 9 patients. In vitro testing of the H. influenzae isolates showed that 6 of 10 were resistant to ampicillin; all were sensitive to amoxicillin/clavulanic acid, ceftriaxone, and cefuroxime. All cases responded well to medical antibiotic treatment. Final best spectacle-corrected visual acuity ranged from no light perception to 20/30. CONCLUSION H. influenzae is a rare cause of corneal ulceration. Predisposing factors for infection are usually present. Accurate diagnosis and treatment may preserve ocular integrity and visual acuity.
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Affiliation(s)
- Kai-Shiang Yang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China
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Chen HC, Tan HY, Hsiao CH, Huang SCM, Lin KK, Ma DHK. Amniotic Membrane Transplantation for Persistent Corneal Ulcers and Perforations in Acute Fungal Keratitis. Cornea 2006; 25:564-72. [PMID: 16783145 DOI: 10.1097/01.ico.0000227885.19124.6f] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To report the therapeutic effect and complications of amniotic membrane transplantation (AMT) in acute fungal keratitis. METHODS Diagnosis of fungal keratitis was confirmed by cultures in 23 eyes of 23 patients. The indications to perform AMT were to promote reepithelialization in non-healing ulcers or to prevent corneal perforation. Antifungal agents were administered throughout the whole course of hospitalization. Repeated cultures were performed immediately before AMT. The main outcome measurements were epithelial healing rate, necessity of therapeutic penetrating keratoplasty (TPK), and persistence of infection. RESULTS During a mean follow-up time of 20.6 months +/- 23.22 (6-65 months) AMT was performed during the active phase of the keratitis (fungal culture was still positive) in 16 patients (69.6%), and during the inactive phase (fungal culture negative) in 7 patients (30.4%). Single-layer AMT was performed in 17 patients, and double-layer AMT was performed in 6 patients with corneal perforation and anterior chamber collapse. Complete epithelialization was observed in 12 patients (75%) in the active group and in 7 patients (100%) in the inactive group. Treatment failure requiring TPK was experienced in 4 patients (25%) in the active group. Persistent fungal keratitis was noted in 2 patients (8.7%) in that group. The final visual acuity improved in 17 cases, worsened in 2 cases, and remained unchanged in 4 cases. Twelve of the 23 eyes (52.2%) in this study preserved useful vision (20/400 and better) with or without subsequent surgeries. CONCLUSION AMT is effective in promoting epithelialization and preventing corneal perforations in acute fungal keratitis, and there is no risk of rejection. However, the risk of persistent or recurrent infection necessitates continued antifungal treatment and patient monitoring.
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Affiliation(s)
- Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Matsumoto Y, Dogru M, Goto E, Fujishima H, Tsubota K. Successful Topical Application of a New Antifungal Agent, Micafungin, in the Treatment of Refractory Fungal Corneal Ulcers. Cornea 2005; 24:748-53. [PMID: 16015098 DOI: 10.1097/01.ico.0000154390.28254.54] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the efficacy of topical application of a new antifungal agent, micafungin (MCFG), in the treatment of yeast-related corneal ulcers. DESIGN Noncomparative interventional case reports. PARTICIPANTS Three patients with yeast-related corneal ulcer after keratoplasty recalcitrant to conventional antifungal treatment for 4 weeks were recruited in this study. METHODS Topical 0.1% antifungal MCFG eye drops were applied in 3 patients with yeast-related corneal ulcer every hour while awake until epithelialization. After epithelialization, the frequency of eye drops was reduced to 5 times a day. MCFG eye drops were discontinued 1 month after the disappearance of stromal infiltration in each case. The patients underwent best corrected visual acuity (BCVA) measurements, slit-lamp examination, fluorescein-dye staining, and anterior segment photography. Corneal scrapings and cultures of surgical materials were also performed. MAIN OUTCOME MEASURES Changes in ulcer size, stromal infiltration, fluorescein dye staining, and BCVA were looked for. RESULTS All corneal ulcers epithelialized within 14 days after commencement of application of 0.1% MCFG eye drops. Yeasts were detected from corneal smears in all eyes. Two cases revealed positive culture isolates for Candida albicans and Candida parapsilosis. No recurrence of fungal keratitis was observed in any of the cases throughout the follow-up periods. CONCLUSION Topical 0.1% MCFG eye drops seem to be an effective and a promising option in the treatment of refractory yeast-related corneal ulcers.
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Geria RC, Wainsztein RD, Brunzini M, Brunzini R, Geria MA. Infectious Keratitis in the Corneal Graft: Treatment With Partial Conjunctival Flaps. Ophthalmic Surg Lasers Imaging Retina 2005. [DOI: 10.3928/1542-8877-20050701-08] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Al-Swailem SA, Al-Rajhi AA, Wagoner MD. Penetrating keratoplasty for macular corneal dystrophy. Ophthalmology 2005; 112:220-4. [PMID: 15691554 DOI: 10.1016/j.ophtha.2004.08.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Accepted: 08/19/2004] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To determine the prognosis of penetrating keratoplasty (PK) for macular corneal dystrophy (MCD). DESIGN Single-center, retrospective, interventional, noncomparative case series. PARTICIPANTS One hundred forty-one patients (229 eyes) with MCD. INTERVENTION Retrospective review of the medical record of every patient who underwent primary PK for histopathologically confirmed MCD at the King Khaled Eye Specialist Hospital between January 1, 1983 and December 31, 2002 and for whom at least 12 months of follow-up is available. MAIN OUTCOME MEASURES Visual acuity (VA), graft survival, and postoperative complications. RESULTS After a mean follow-up period of 5.9+/-3.8 years (range, 1-17), the mean best-corrected VA was 20/50. At the most recent visit, 206 (90.0%) grafts were clear, and 23 (10.0%) had failed. Probabilities of graft survival were 98.1% at 1 year, 89.8% at 5 years, 82.1% at 10 years, and 74.1% at 15 years. There was a statistically significant increased likelihood of graft failure if the patient was older than 40 years at the time of surgery (P<0.00003). The differences in graft failure between patients older than 40 and those younger were not attributable to statistically significant differences in duration of follow-up, donor age, or donor endothelial cell counts. Corneal endothelial rejection episodes occurred in 47 (20.0%) grafts, but resulted in irreversible graft failure in only 8 (3.5%) eyes. Eighteen (27.3%) of 66 eyes with a recipient size of > or =7.5 mm developed a graft rejection episode, compared with 27 (16.6%) of 163 eyes with a recipient size of <7.5 mm (P = 0.04). Microbial keratitis occurred in 14 (6.1%) grafts and was more likely to occur in patients over 40 (14.0% vs. 3.0%, P = 0.01). Clinically significant recurrence was observed in 12 (5.2%) grafts, after a mean interval of 84+/-48.2 months, and was directly related to patient age (P = 0.04) and inversely related to donor graft size (P = 0.04). CONCLUSIONS Good visual results and excellent graft survival can be achieved after PK for MCD. The risk of graft failure is higher in patients older than 40 years.
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Affiliation(s)
- Samar A Al-Swailem
- Anterior Segment Division, Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
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Proano CE, Azar DT, Mocan MC, Redmond RW, Kochevar IE. Photochemical keratodesmos as an adjunct to sutures for bonding penetrating keratoplasty corneal incisions. J Cataract Refract Surg 2004; 30:2420-4. [PMID: 15519099 DOI: 10.1016/j.jcrs.2004.02.068] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2004] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the benefit of photochemical keratodesmos (PKD) in acute wound closure of penetrating keratoplasty (PKP) corneal incisions in vivo. SETTING Massachusetts General Hospital and Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. METHODS Penetrating keratoplasty incisions were performed in both eyes of 6 New Zealand white rabbits, followed by application of 1.5 mM rose bengal dye at the wound edges. The incision in 1 eye of each rabbit was irradiated with neodymium:YAG laser light at 532 nm and fluence of 40 J/cm2; the contralateral control eye was untreated. Intraocular pressure at which fluid leaked at the edges (IOPL) was determined immediately after surgery. RESULTS The mean IOPL was 410 mm Hg +/- 70 (SD) in the PKD-treated eyes and 250 +/- 150 mm Hg in the unirradiated eyes. The difference was statistically significant by paired t test (P<.05). CONCLUSIONS Photochemical keratodesmos may be a useful adjunct to sutures for approximating PKP corneal incisions in the immediate postoperative period. This process does not induce high temperature, and thus denaturation can be avoided and structural integrity restored.
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Affiliation(s)
- Cinthia E Proano
- Massachusetts Eye and Ear Infirmary and the Schepens Eye Research Institute, Massachusetts General Hospital, Boston, MA 02114, USA
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Sharma N, Gupta V, Vanathi M, Agarwal T, Vajpayee RB, Satpathy G. Microbial Keratitis Following Lamellar Keratoplasty. Cornea 2004; 23:472-8. [PMID: 15220732 DOI: 10.1097/01.ico.0000116525.57227.59] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the predisposing factors, etiologic agents, and clinical and visual outcomes in infectious keratitis following lamellar keratoplasty (LK). METHODS One hundred thirty-five eyes (135 patients) that had undergone LK were retrospectively analyzed for the occurrence of infectious keratitis following LK. The parameters evaluated were predisposing factors, seasonal variation, indications and type of LK, time interval between LK and infection, site and depth of infection, etiologic organisms, type of treatment, outcome in terms of graft status, secondary surgery, visual acuity, and the donor tissue profile. RESULTS The incidence of infectious keratitis following LK was 11.11%. The most significant predisposing factor was persistent epithelial defect (3 eyes) and suture abscesses (3 eyes). Most cases occurred between May and August (9/15). Twelve cases developed infection within 2 weeks of surgery (80%). Seven cases (7/15) occurred with onlay grafts, 6 with inlay grafts, and 2 with large-diameter LK. Cultures of corneal scrapings were positive in 11 eyes (73.3%), and the most common isolated organism was coagulase-negative Staphylococcus (CNS). Only 2 eyes responded to medical therapy, and graft sloughing occurred in 9 cases. Six eyes underwent penetrating keratoplasty to either salvage the integrity of globe or for visual rehabilitation of cases where infection resulted in corneal opacity. CONCLUSIONS Infections after LK may not be amenable to antimicrobial therapy and may necessitate the removal of the graft or a therapeutic penetrating keratoplasty.
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Affiliation(s)
- Namrata Sharma
- Department of Cornea, Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Yao YF, Zhang YM, Zhou P, Zhang B, Qiu WY, Tseng SCG. Therapeutic penetrating keratoplasty in severe fungal keratitis using cryopreserved donor corneas. Br J Ophthalmol 2003; 87:543-7. [PMID: 12714387 PMCID: PMC1771670 DOI: 10.1136/bjo.87.5.543] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To investigate whether cryopreserved donor cornea could be used for therapeutic penetrating keratoplasty (PKP) to eradicate the infection, obviate complications, and preserve anatomical integrity in severe fungal keratitis. METHODS In this retrospective, consecutive case series, 45 eyes of 45 patients with severe fungal keratitis, which exhibited anterior chamber collapse, corneal perforation, and/or large suppurative corneal infiltrate, received therapeutic PKP after removal of the infected corneal tissue, irrigation of the anterior chamber by 0.2% fluconazole solution, iris dissection of fibrinoid membrane, and iridectomy and therapeutic PKP using corneas cryopreserved at -20 degrees C. RESULTS Among 45 eyes, 39 eyes (86.7%) were successfully eradicated the fungal infection without recurrence and maintained their anatomical integrity without any complication. Four of 45 eyes (8.9%) showed postoperative rise of intraocular pressure, of which three were controlled with subsequent antiglaucoma surgeries, whereas one eye needed additional antiglaucoma medications. Two of 45 eyes (4.4%) were enucleated because of uncontrollable fungal infection and secondary retinal detachment, respectively. 23 eyes received subsequent optical PKP and, among them, 21 maintained clear corneal grafts and two suffered from graft failure due to allograft rejections. CONCLUSION Cryopreserved donor corneas are effective substitutes in therapeutic PKP to control severe fungal corneal infection and preserve the global integrity, and may offer additional advantages over conventional PKP in reducing allograft rejection, eradicating fungal infection during the postoperative period, and improving the success of optical PKP for visual rehabilitation.
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Affiliation(s)
- Y-F Yao
- Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, P R China.
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Bawazeer AM, Hodge WG. Rhodotorula infection in a corneal graft following penetrating keratoplasty. CANADIAN JOURNAL OF OPHTHALMOLOGY 2003; 38:225-7. [PMID: 12733691 DOI: 10.1016/s0008-4182(03)80065-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ahmed M Bawazeer
- Department of Ophthalmology, Faculty of Medicine and Allied Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Sonavane A, Sharma S, Gangopadhyay N, Bansal AK. Clinico-microbiological correlation of suture-related graft infection following penetrating keratoplasty. Am J Ophthalmol 2003; 135:89-91. [PMID: 12504703 DOI: 10.1016/s0002-9394(02)01857-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the clinical and microbiological profiles of suture-related graft infections following penetrating keratoplasty. DESIGN Interventional case series. METHODS The medical and microbiology records of all patients who presented with suture-related graft infections and were seen between January 1999 and December 2001 were reviewed. RESULTS Of 105 patients (105 eyes) who developed corneal infiltrates following penetrating keratoplasty, 37 patients (24 optical and 13 therapeutic) were identified as having suture-related graft infection. The median onset of infiltrates after penetrating keratoplasty was 87 days for 31 patients who presented within one year. Gram-stained smears of corneal scrapings were positive in 27 (73%) of 37 patients, whereas cultures were positive in 32 (only bacteria, 30; mixed bacteria and fungi, 2). Thirty-seven isolates were obtained from 32 patients (gram-positive bacteria, 32; gram-negative bacteria, 3; fungus, 2). All gram-positive isolates were sensitive to cefazolin, chloramphenicol, and vancomycin, whereas one of three gram-negative isolates (Pseudomanas species) was resistant to all the antibiotics tested. Of 32 patients, 30 (82%) responded satisfactorily to medical management. CONCLUSIONS Suture-related graft infections are usually caused by bacteria that are sensitive to ciprofloxacin, cefazolin, and gentamicin, and the patients respond satisfactorily to medical therapy.
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Affiliation(s)
- Abhijit Sonavane
- Cornea Service, L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India
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Abstract
PURPOSE To report an epicorneal aspergilloma in a postkeratoplasty patient with a bandage soft contact lens. METHODS Case report of a 77-year-old postkeratoplasty patient who presented with an epicorneal mass under a bandage soft contact lens placed for a nonhealing epithelial defect. On removal of the contact lens, a 4 x 4-mm placoid mass fell free from the corneal surface and was sent for culture and histopathology. RESULTS Gram stain demonstrated septated branching hyphae, and cultures confirmed the diagnosis of Histopathologic sections of the epicorneal mass revealed a full-thickness aspergilloma. CONCLUSION Contact lens removal and aggressive antimycotic treatment resulted in epithelial healing and resolution of the keratomycosis. The patient remained stable for 6 months followed by a successful repeat penetrating keratoplasty.
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Affiliation(s)
- E D Weichel
- Department of Ophthalmology, Eisenhower Army Medical Center, Fort Gordon, GA 30905-5650, USA.
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Abstract
PURPOSE To evaluate the effect of a new suturing technique on postkeratoplasty visual rehabilitation time and refractive error. METHODS Penetrating keratoplasty was performed on 17 eyes with keratoconus using a modified suturing technique. A donor button 8.0 mm in diameter was sutured into a 7.75-mm recipient bed with both deep and superficial sutures. The deep sutures consisted of either a single 16-bite 10-0 nylon running suture (n = 7) or eight interrupted 10-0 nylon cross-stitches (n = 10). These sutures were passed into the mid-stroma of the donor cornea and exited through the donor endothelium, then passed through the endothelium of the recipient cornea and exited from its mid-stroma. Thereby all parts of the deep sutures remained below the corneal surface. To further secure the surgical wound, in each case a running 16-bite 10-0 nylon superficial suture was also placed. Care was taken to maintain the bites of the superficial suture above the level of the deep sutures. The superficial suture was removed 3 months after surgery. Vision and refraction were recorded 1 day and 1 month postoperatively and 1 and 3 months after suture removal. A paired Student test was used to verify the significance of changes in visual acuity and refraction recorded at different examination times. RESULTS As early as 1 month after surgery, spectacle best-corrected visual acuity 20/40 or more and refractive astigmatism less than 4 diopters (D) were recorded in each eye and maintained with two exceptions at the later examination times. In two patients, postoperative astigmatism increased from 4.5 to 5 D after suture removal. CONCLUSIONS Deep suturing allowed quick visual rehabilitation while minimizing postkeratoplasty astigmatism in the patients with keratoconus operated on in this series.
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Machado RAM, Mannis MJ, Mandel HA, Feiz V, Schwab IR, Wang W, Wang JL. The relationship between first postoperative day epithelial status and eventual health of the ocular surface in penetrating keratoplasty. Cornea 2002; 21:574-7. [PMID: 12131033 DOI: 10.1097/00003226-200208000-00008] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine a possible relationship between donor epithelial status on the first postoperative day after keratoplasty and the eventual health of the corneal surface. METHODS We analyzed 91 patients who underwent penetrating corneal transplantation between January 1998 and January 2000, monitoring the epithelial status of the corneas with fluorescein staining using slit-lamp biomicroscopy. Recipient pre- and postoperative variables and donor characteristics were recorded. Macroepithelial defects were classified into three groups according to the extent of the epithelial defect. The results on the first postoperative day were compared with the first and third operative month. Donor and recipient variables were compared with the epithelial status on the first and third month as well. RESULTS On the first postoperative day, 64.84% of the patients had epithelial defects, 10.99% had defects at the 1-month postoperative visit, and none had defects at the third month. Graft recipients with macroepithelial defects in the first postoperative month were older, had a higher prevalence of blepharitis, higher prevalence of inadequate eye hydration, and slightly increased corneal sensation compared with the group without epithelial defects; however, none of these trends were statistically significant. Patients with macroepithelial defects in the first postoperative month received older donor tissue, and the average preservation-to-surgery time was longer. These donor variables, however, were not significant statistically (p value >0.10) in determining outcome of the epithelial status at the first or third months. CONCLUSIONS Our results suggest that the epithelial status on the first postoperative day is not predictive of surface integrity at 1-month postoperative (p value is 0.2676 for the likehood ratio test). The epithelial status on the first postoperative day is not predictive of the status of the third month after keratoplasty, because none of the 91 patients had epithelial defects after 3 months.
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Affiliation(s)
- Renato A M Machado
- Department of Ophthalmology, University of California-Davis, 4860 Y Street, Suite 2400, Sacramento, CA 95817, USA
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Vajpayee RB, Boral SK, Dada T, Murthy GVS, Pandey RM, Satpathy G. Risk factors for graft infection in India: a case-control study. Br J Ophthalmol 2002; 86:261-5. [PMID: 11864877 PMCID: PMC1771032 DOI: 10.1136/bjo.86.3.261] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To study the demographic, clinical, and microbiological profile and the risk factors for graft infection following penetrating keratoplasty. METHODS 50 eyes of 50 consecutive patients with graft infection after an optical penetrating keratoplasty were included as cases; 50 eyes of 50 patients with no graft infection were included as controls. The main variables evaluated in this study included the clinical and microbiological profile, sociodemographic status, suture related problems, persistent epithelial defects, and ocular surface disorders. RESULTS Cultures were positive in 43 (86%) eyes and Staphylococcus epidermidis (67.4%) was the most common organism isolated. Infection could be resolved with treatment in 37 (74%) eyes. In eight (16%) eyes the graft melted and a repeat penetrating keratoplasty had to be performed. Only 6% of the cases could achieve a best corrected visual acuity of 6/18 or better after resolution of the infection. In multivariate logistic regression analysis persistent epithelial defect (OR (95% CI): 3.0 (1.17 to 8.33)), suture related problems (OR (95% CI): 3.6 (1.39 to 9.25)), and ocular surface disorders (OR (95% CI): 2.4 (0.93 to 6.03)) were found to be statistically significant risk factors for graft infection following an optical penetrating keratoplasty. CONCLUSIONS Staphylococcus epidermidis is the commonest organism responsible for post-keratoplasty microbial keratitis. Persistent epithelial defects, suture related problems, and ocular surface disorders are the major risk factors predisposing to graft infection.
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Affiliation(s)
- R B Vajpayee
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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