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Sakakura S, Yamazaki R, Uchino Y, Negishi K, Shimmura S. Non-Descemet stripping endothelial keratoplasty for bullous keratopathy in patients with atopic dermatitis: A long-term case report. Medicine (Baltimore) 2024; 103:e39767. [PMID: 39331883 PMCID: PMC11441933 DOI: 10.1097/md.0000000000039767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2024] Open
Abstract
RATIONALE Patients with atopic dermatitis undergoing penetrating keratoplasty (PKP) face a high risk of postoperative complications. Endothelial keratoplasty may be a safer alternative for such patients, including those with abnormal anterior chamber anatomy. PATIENT CONCERNS 3 male patients, aged 33 to 44, presented with blurred vision at Keio University Hospital. DIAGNOSIS Bullous keratopathy was diagnosed through slit-lamp examination and specular microscopy. Two patients had well-controlled systemic atopic dermatitis, while 1 had blepharitis associated with atopic dermatitis. Two patients had peripheral anterior synechia, and 2 had undergone glaucoma surgery before keratoplasty. INTERVENTIONS Non-Descemet stripping endothelial keratoplasty (nDSAEK) was performed by a single surgeon. OUTCOMES The best-corrected visual acuity ranged from 0.7 to 1.5 logMAR before surgery and from 0.2 to 2.3 logMAR after surgery. One year post-surgery, the graft remained clear in 2 cases; however, in the case of repeated glaucoma surgeries after nDSAEK, the graft became edematous. Corneal endothelial cell density was 1586 and 1988 cells/mm² in 2 cases and undetectable in the failed case. The follow-up period ranged from 2.5 to 9 years. LESSONS Despite the presence of peripheral anterior synechia or prior glaucoma surgery, some patients experienced a favorable long-term postoperative course following nDSAEK. This procedure may offer a safer alternative for treating patients with atopic dermatitis who have ocular complications that present a high risk for PKP.
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Affiliation(s)
- Saki Sakakura
- Department of Ophthalmology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
- Department of Clinical Regenerative Medicine, Fujita Medical Innovation Center, Fujita Health University, Ota-ku, Tokyo, Japan
| | - Risa Yamazaki
- Department of Ophthalmology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yuichi Uchino
- Department of Ophthalmology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shigeto Shimmura
- Department of Ophthalmology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
- Department of Clinical Regenerative Medicine, Fujita Medical Innovation Center, Fujita Health University, Ota-ku, Tokyo, Japan
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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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3
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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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Ong HS, Sharma N, Phee LM, Mehta JS. Atypical microbial keratitis. Ocul Surf 2023; 28:424-439. [PMID: 34768003 DOI: 10.1016/j.jtos.2021.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 01/16/2023]
Abstract
Atypical microbial keratitis refers to corneal infections caused by micro-organisms not commonly encountered in clinical practice. Unlike infections caused by common bacteria, cases of atypical microbial keratitis are often associated with worse clinical outcomes and visual prognosis. This is due to the challenges in the identification of causative organisms with standard diagnostic techniques, resulting in delays in the initiation of appropriate therapies. Furthermore, due to the comparatively lower incidence of atypical microbial keratitis, there is limited literature on effective management strategies for some of these difficult to manage corneal infections. This review highlights the current management and available evidence of atypical microbial keratitis, focusing on atypical mycobacteria keratitis, nocardia keratitis, achromobacter keratitis, and pythium keratitis. It will also describe the management of two uncommonly encountered conditions, infectious crystalline keratopathy and post-refractive infectious keratitis. This review can be used as a guide for clinicians managing patients with such challenging corneal infections.
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Affiliation(s)
- Hon Shing Ong
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore; Tissue Engineering and Cell Therapy Department, Singapore Eye Research Institute, Singapore; Department of Ophthalmology and Visual Science, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore.
| | - Namrata Sharma
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Lynette M Phee
- Department of Pathology, Sengkang General Hospital, SingHealth, Singapore
| | - Jodhbir S Mehta
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore; Tissue Engineering and Cell Therapy Department, Singapore Eye Research Institute, Singapore; Department of Ophthalmology and Visual Science, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore; School of Material Science & Engineering and School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore.
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Liu S, Wong YL, Walkden A. Current Perspectives on Corneal Transplantation. Clin Ophthalmol 2022; 16:631-646. [PMID: 35282172 PMCID: PMC8904759 DOI: 10.2147/opth.s289359] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/20/2022] [Indexed: 12/18/2022] Open
Abstract
Disease of the cornea is the third leading cause of blindness worldwide. Corneal graft surgery is one of the most successful forms of solid organ transplantations in humans, with ever-increasing developments in surgical technique. To date, approximately 4504 corneal transplants are performed in the United Kingdom each year. While full thickness transplantation was the most commonly performed keratoplasty over the last few decades, selective lamellar transplantation of the diseased layers of the cornea has been universally adopted. This comprehensive review aims to provide an updated synthesis on different types of corneal transplantations, their treatment outcomes, and the associated complications of each procedure in both adult and paediatric population. In addition, we also present an up-to-date summary of the emerging therapeutic approaches that have the potential to reduce the demand for donor-dependent keratoplasty.
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Affiliation(s)
- Siyin Liu
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Yee Ling Wong
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Andrew Walkden
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Correspondence: Andrew Walkden, Email
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Bor’i A, El-Haig WM. Combined Photoactivated Chromophore for Infectious Keratitis-Corneal Collagen Cross-Linking (PACK-CXL) and Therapeutic Penetrating Keratoplasty for Resistant Bacterial Keratitis. Clin Ophthalmol 2022; 16:273-279. [PMID: 35140457 PMCID: PMC8820449 DOI: 10.2147/opth.s348835] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/16/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Ashraf Bor’i
- Ophthalmology Department, Zagazig University, Zagazig, Sharkia, Egypt
- Alfat’h Eye Hospital, Zagazig, Sharkia, Egypt
- Correspondence: Ashraf Bor’i, Ophthalmology Department, Zagazig University, PO Box 44286, Zagazig, Sharkia, Egypt, Tel +20 1065338080, Email
| | - Wael M El-Haig
- Ophthalmology Department, Zagazig University, Zagazig, Sharkia, Egypt
- Alfat’h Eye Hospital, Zagazig, Sharkia, Egypt
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Dave A, Sawant S, Acharya M, Gandhi A, Majumdar A, Mathur U. Post penetrating keratoplasty infectious keratitis: Clinico-microbiological profile and predictors of outcome. Eur J Ophthalmol 2021; 32:2652-2661. [PMID: 34812082 DOI: 10.1177/11206721211062979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To study the clinico-microbiological profile, outcomes and prognostic factors of post penetrating keratoplasty (PKP) infectious keratitis. METHODS Retrospective review of medical records of 78 patients with post PKP infectious keratitis presenting between January 2014 and December 2018. Demographic, clinical and microbiological profile was documented and predictors of treatment and graft success were evaluated using univariate and subsequent multivariate logistic regression analysis. RESULTS Mean age of patients was 52.17 ± 15.51 years and mean infiltrate size was 19.39 ± 19.68 mm2. Mean duration of presentation with infection post PKP was 11.66 ± 10.65 months. Culture positivity was seen in 64 eyes (82.05%). Bacterial growth was observed in 47 eyes (60.25%), fungal growth in 17 (21.79%) and no microbiological growth in 14 eyes (17.94%). At 3 months the visual acuity (VA) improved in 37 eyes (47.44%), did not change in 27 (34.62%) and deteriorated in 14 (17.95%). Graft failure was noted in 53 eyes (73.08%). Surgical intervention was needed in 47 (60.25%) eyes of which most common was therapeutic PKP in 32 eyes (41.02%). Treatment failure was noted with fungal infection (p = 0.05), poorer vision at presentation (p = 0.02), larger infiltrate area (p = 0.002) and graft infection developing before 1 year (p = 0.02). Graft failure was noted with associated endophthalmitis (p = 0.02), poorer VA at presentation (p = 0.01) and larger infiltrate area (p = 0.02). CONCLUSION Post PKP infectious keratitis is a sight threatening ocular condition. It is associated with high incidence of graft failure and frequently requires surgical intervention. Fungal etiology, larger infiltrate size, poorer vision at presentation and associated endophthalmitis carries a poorer prognosis.
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Affiliation(s)
- Abhishek Dave
- Cornea & Refractive Surgery Services, 75838Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Sanil Sawant
- Cornea & Refractive Surgery Services, 75838Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Manisha Acharya
- Cornea & Refractive Surgery Services, 75838Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Arpan Gandhi
- Lab Services, 75838Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Atanu Majumdar
- Department of Statistics, 75838Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Umang Mathur
- Cornea & Refractive Surgery Services, 75838Dr Shroff's Charity Eye Hospital, New Delhi, India
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Gümüş G, Kırgız A, Yıldırım Y, Kandemir Beşek N, Genç S, Kepez Yıldız B, Taşkapılı M. Prognostic Factors Affecting Graft Survival in Patients Undergoing Penetrating Keratoplasty for Infectious Keratitis. Turk J Ophthalmol 2021; 50:324-331. [PMID: 33389931 PMCID: PMC7802093 DOI: 10.4274/tjo.galenos.2020.35305] [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: To evaluate the prognostic factors affecting graft survival in patients undergoing penetrating keratoplasty (PKP) for infectious keratitis. Materials and Methods: Patients who underwent PKP for keratitis in our hospital between 2013 and 2018 were retrospectively reviewed. Patients who underwent therapeutic PKP at the inflammatory stage and were followed for at least 12 months were included in the study. Age, gender, follow-up period, time between diagnosis and surgery, lens status, presence of limbal involvement, presence of corneal ulceration, perforation, or corneal abscess, type of microorganism detected in culture, number of fortified medications used before surgery and duration of use, preoperative and postoperative visual acuity, postoperative graft transparency, postoperative complications, recurrence of infection, rate of re-keratoplasty, and indication for and timing of re-keratoplasty were recorded. The relationship between these findings and anatomic, therapeutic, and functional success were evaluated. Results: Fifty-nine patients were included in the study; 40 (67.8%) were male and 19 (32.2%) were female, and the mean age was 59.78±19.46 (6-91) years. Anatomic success was achieved in 58 patients (98.3%). Therapeutic success was achieved in 47 patients (79.7%) and there was a significant relationship between therapeutic success and re-keratoplasty and early re-keratoplasty (p<0.001 for both). Thirty-two patients (54.2%) had functional success and there was a significant relationship between the absence of postoperative complications and functional success (p=0.014). Conclusion: PKP is an effective treatment option in treatment-resistant keratitis or keratitis with impending perforation. The absence of postoperative complications and performing early re-keratoplasty in patients with recurrence increase the success rate.
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Affiliation(s)
- Gülşah Gümüş
- University of Health Sciences Turkey İstanbul Beyoğlu Ophthalmology Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Kırgız
- University of Health Sciences Turkey İstanbul Beyoğlu Ophthalmology Training and Research Hospital, İstanbul, Turkey
| | - Yusuf Yıldırım
- University of Health Sciences Turkey İstanbul Beyoğlu Ophthalmology Training and Research Hospital, İstanbul, Turkey
| | - Nilay Kandemir Beşek
- University of Health Sciences Turkey İstanbul Beyoğlu Ophthalmology Training and Research Hospital, İstanbul, Turkey
| | - Selim Genç
- University of Health Sciences Turkey İstanbul Beyoğlu Ophthalmology Training and Research Hospital, İstanbul, Turkey
| | - Burçin Kepez Yıldız
- University of Health Sciences Turkey İstanbul Beyoğlu Ophthalmology Training and Research Hospital, İstanbul, Turkey
| | - Muhittin Taşkapılı
- University of Health Sciences Turkey İstanbul Beyoğlu Ophthalmology Training and Research Hospital, İstanbul, Turkey
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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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Park DH, Nam JW, Yoon HJ, Yoon KC. Clinical Manifestations of Fungal Keratitis Following Penetrating Keratoplasty. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.4.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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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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12
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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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14
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Keratitis Caused by Candida parapsilosis and Subsequent Corynebacterium macginleyi Infection: Case Report and Short Review. Eye Contact Lens 2020; 46:e27-e29. [PMID: 32576753 DOI: 10.1097/icl.0000000000000628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Keratitis due to Candida parapsilosis or Corynebacterium macginleyi is uncommon. We present a patient with several risk factors who suffered two subsequent corneal infections caused by these pathogens and healed with topical conservative therapy. The important factor was the early detection of infection. Fluconazole solution administered topically as eye drops combined with regular debridement proved in this case a successful alternative to systemic antifungal treatment. With a perceived recurrence of the keratitis, one must take into account the involvement of other pathogens present. The previous use of an antifungal solution other than a conventional eye drop could be an additional risk factor for a second bacterial infection, but the benefits should still rule in favor of such a treatment.
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Okumura Y, Inomata T, Miyamoto S, Nakatani S, Hiratsuka Y, Yamaguchi M, Iwamoto S, Murakami A. Donor characteristics and risk factors for methicillin-resistant Staphylococcus aureus contamination in storage medium for corneal transplantation: A 10-year retrospective study. Transpl Infect Dis 2019; 21:e13123. [PMID: 31165536 DOI: 10.1111/tid.13123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/21/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE This study investigated the donor characteristics of methicillin-resistant Staphylococcus aureus (MRSA) contamination in storage medium before transfer of corneas to preservation medium for corneal transplantation, in order to identify donor characteristic risk factors for MRSA contamination. METHODS This retrospective, cross-sectional study was performed using Juntendo Eye Bank records for all corneal transplantation procedures. Storage medium (EP-II® ) cultures for right eyes were included for the period between July 2008 and December 2017. The following donor characteristics were collected: age, sex, cause of death, history of cataract surgery, death-to-enucleation interval, death-to-preservation interval, and endothelial cell density (ECD). Donor characteristics were compared between MRSA and non-MRSA contamination groups. Odds ratios (ORs) for donor-related risk factors for MRSA contamination were determined using logistic regression. RESULTS In total, 370 storage medium samples were examined; 222 were positive for bacterial cultures (60.0%) and 36 were MRSA-positive (9.7%). Donor age was significantly higher in the MRSA contamination group than in the non-MRSA contamination group (86.1 ± 9.5 years vs 75.9 ± 15.9 years, P < 0.001). Univariate logistic regression analysis showed that MRSA contamination risk factors were older age (OR = 1.07; 95% confidence interval [95% CI]: 1.03-1.11) and decreased ECD (OR = 0.9993; 95% CI: 0.9986-0.9992). The fully adjusted OR for every year of age as a risk factor for MRSA contamination was 1.07 (95% CI: 1.03-1.11). CONCLUSIONS Aging was a risk factor for MRSA contamination in storage medium. Careful pre-banking assessment of elderly donor corneas is needed to prevent intractable postoperative MRSA infection.
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Affiliation(s)
- Yuichi Okumura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Strategic Operating Room Management and Improvement, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takenori Inomata
- Department of Strategic Operating Room Management and Improvement, Juntendo University Faculty of Medicine, Tokyo, Japan.,Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shizuka Miyamoto
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoru Nakatani
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yoshimune Hiratsuka
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masahiro Yamaguchi
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoshi Iwamoto
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo, Japan
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16
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Okonkwo ACO, Siah WF, Hogg HDJ, Anwar H, Figueiredo FC. Microbial keratitis in corneal grafts: predisposing factors and outcomes. Eye (Lond) 2018; 32:775-781. [PMID: 29386617 DOI: 10.1038/eye.2017.310] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 11/18/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeTo identify the nature of microbial keratitis in corneal grafts and the clinical outcomes at a tertiary hospital in the United Kingdom.Patients and methodsA retrospective case series of microbial keratitis in corneal grafts at the Royal Victoria Infirmary, Newcastle upon Tyne over a 17-year period (1997-2014).ResultsA total of 759 consecutive corneal grafts were identified from the Cornea Transplantation database. Of these, 59 episodes of microbial keratitis occurred in 41 eyes of 41 patients (5.4%; 19 male, 46.3%). Median patient age was 73 years (SD=19.4 years). The most common indication for corneal transplantation was bullous keratopathy (11/41, 26.8%). There were 34/59 (57.6%) episodes of culture-positive graft keratitis; Streptococcus pneumoniae and Staphylococcus aureus were each isolated in 5/34 (14.7%) culture-positive episodes. In all, 35/59 (59.3%) episodes of microbial keratitis occurred in 22 previously failed grafts and 3 de novo graft failures. Gram-negative keratitis was more likely to cause reduced BCVA after (χ2-test, P=0.02). Median graft duration was 49.5 months (SD=43.7 months). Failed grafts were significantly older (median 69 vs 27 months, P=0.009).ConclusionThis represents the longest published follow-up data on microbial keratitis and is the only of its kind in the United Kingdom. The incidence of 5.4% is comparable to that within the developed world. Graft age was significantly associated with graft failure in microbial keratitis; the ongoing risk of microbial keratitis warrants providing patients with long-term open access to hospital eye services.
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Affiliation(s)
- A C O Okonkwo
- Newcastle University, Newcastle upon Tyne, UK.,Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - W F Siah
- Newcastle University, Newcastle upon Tyne, UK
| | - H D J Hogg
- Newcastle University, Newcastle upon Tyne, UK.,Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - H Anwar
- Newcastle University, Newcastle upon Tyne, UK
| | - F C Figueiredo
- Newcastle University, Newcastle upon Tyne, UK.,Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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17
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18
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Infectious crystalline keratopathy. Surv Ophthalmol 2017; 63:480-499. [PMID: 29097211 DOI: 10.1016/j.survophthal.2017.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 10/15/2017] [Accepted: 10/19/2017] [Indexed: 01/07/2023]
Abstract
Infectious crystalline keratopathy was first reported by Gorovoy and colleagues in 1983 when they identified bacteria colonizing a cornea after a penetrating keratoplasty. Subsequent cases have elaborated on the organisms responsible and the management outcomes. Patients present with a white or gray branching opacity originating from an epithelial defect, commonly after a penetrating keratoplasty. Local immunosuppression contributes to the quiescent nature and the limited inflammatory response associated with infectious crystalline keratopathy. Diagnosis of the infective pathogens may be difficult, with a corneal scraping often being too superficial to obtain an adequate specimen. A biofilm is present that advantages microorganism survival, reduces antibiotic bioavailability, and inhibits diagnostic microbial detection. Treatment begins with topical antimicrobials, initially broad spectrum and then targeted to microorganism sensitivity. Adjunctive therapies to enhance the efficacy of treatment include disruption of the microorganism biofilm by laser, intrastromal antibiotics, and keratectomy. In recalcitrant cases, or where corneal scarring ensues, corneal transplantation is required.
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19
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Inomata T, Ono K, Matsuba T, Shiang T, Di Zazzo A, Nakatani S, Yamaguchi M, Ebihara N, Murakami A. Pre-banking microbial contamination of donor conjunctiva and storage medium for penetrating keratoplasty. Jpn J Ophthalmol 2017; 61:369-377. [PMID: 28597192 DOI: 10.1007/s10384-017-0521-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 05/09/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE The aims of this study were to investigate the incidence of positive donor tissue cultures before transfer to preservation medium (Optisol™-GS) for penetrating keratoplasty, to verify the efficacy of antibiotics contained in Optisol™-GS by examining the drug susceptibility and to assess the relationship between the results of our microbial assessments as well as donor factors and the incidence of contamination. METHODS We conducted a retrospective, cross-sectional study using Juntendo Eye Bank records for all corneal transplantations. Two hundred donor conjunctiva harvestings and storage medium (EP-II®) cultures were performed between July 2008 and June 2011. We analyzed the associations between donor factors (age, gender, history of cataract surgery, death-to-preservation interval, cause of death) and contamination rates using multivariate analysis by the generalized estimating equation model. RESULTS We obtained positive bacterial cultures from 154 of the 200 eyes (77.0%). The isolated bacteria were indigenous, such as coagulase-negative Staphylococci, Corynebacterium sp., and methicillin-resistant Staphylococcus aureus (MRSA). There was significant resistance to levofloxacin (18 eyes, 9.0%) and gentamicin (12 eyes, 6.0%), and no vancomycin-resistant bacteria were detected. The donor factors did not correlate with the prevalence of bacterial contamination in our criteria. CONCLUSIONS Pre-banking microbial assessment allows for microbial detection, bacterial susceptibility and resistance testing. This is useful for developing preservation mediums containing effective spectrum antibiotic agents for high quality control of corneal banking.
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Affiliation(s)
- Takenori Inomata
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Bunkyo-ku, 2-1-1 Hongo, Tokyo, 113-0033, Japan.
| | - Koichi Ono
- Department of Ophthalmology, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Koto-ku, Tokyo, Japan
| | - Tsuyoshi Matsuba
- Advanced Research Center for Human Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Tina Shiang
- Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Antonio Di Zazzo
- BioMolecular and Cellular Laboratories in Ophthalmology, IRCCS, G.B. Bietti Foundation, Rome, Italy
| | - Satoru Nakatani
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Bunkyo-ku, 2-1-1 Hongo, Tokyo, 113-0033, Japan
| | - Masahiro Yamaguchi
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Bunkyo-ku, 2-1-1 Hongo, Tokyo, 113-0033, Japan
| | - Nobuyuki Ebihara
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Tomioka, Chiba, Japan
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Bunkyo-ku, 2-1-1 Hongo, Tokyo, 113-0033, Japan
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20
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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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21
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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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22
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Lin IH, Chang YS, Tseng SH, Huang YH. A comparative, retrospective, observational study of the clinical and microbiological profiles of post-penetrating keratoplasty keratitis. Sci Rep 2016; 6:32751. [PMID: 27587283 PMCID: PMC5009354 DOI: 10.1038/srep32751] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 08/15/2016] [Indexed: 11/09/2022] Open
Abstract
Infectious keratitis after penetrating keratoplasty (PK) is a devastating condition that may result in graft failure and poor visual outcome. In this study, we retrospectively reviewed the medical records of patients who underwent PK between 2009 and 2014, and recorded those who developed infectious keratitis. We compared the predisposing factors and organisms isolated to those identified in our previous study, conducted between 1989 and 1994. The incidence of post-PK infectious keratitis decreased from 11.6% (41 out of 354 cases, 1989–1994) to 6.5% (9 out of 138 cases, 2009–2014). Graft epithelial defect and suture-related problems remained the leading two risk factors of infectious keratitis after PK. Gram-positive and Gram-negative bacterial infection decreased from 58.5% and 46.3% to 11.1% and 22.2%, respectively (P = 0.023 and P = 0.271). In contrast, fungus infection increased from 9.8% to 66.7% (P = 0.001); fungi have become the major pathogen for post-PK infectious keratitis. In conclusion, while the incidence of post-PK infectious keratitis has decreased over time, the number and frequency of fungal infections have significantly increased in the recent study period. Clinicians should be aware of the shifting trend in pathogens involved in post-PK infectious keratitis.
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Affiliation(s)
- I-Huang Lin
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Sheng Chang
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Ophthalmology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sung-Huei Tseng
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Hsun Huang
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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24
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Palioura S, Henry CR, Amescua G, Alfonso EC. Role of steroids in the treatment of bacterial keratitis. Clin Ophthalmol 2016; 10:179-86. [PMID: 26869751 PMCID: PMC4734801 DOI: 10.2147/opth.s80411] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Bacterial keratitis can lead to severe visual impairment from corneal ulceration, subsequent scarring, and possible perforation. The mainstay of treatment is topical antibiotics, whereas the use of adjunctive topical corticosteroid drops remains a matter of debate. Herein, we review the rationale for and against the use of topical corticosteroids and we assess their effectiveness and safety in the published randomized controlled trials that have evaluated their role as adjunctive therapy for bacterial corneal ulcers. In the largest study to date, the Steroids for Corneal Ulcers Trial, topical corticosteroid drops were neither helpful nor harmful for the 500 participants as a whole. However, subgroup analyses suggested that topical corticosteroids may be beneficial upon early administration (within 2–3 days after starting antibiotics) for more central corneal ulcers with poorer vision at presentation, for invasive Pseudomonas strains, and for non-Nocardia ulcers. These results are discussed within the limitations of the study.
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Affiliation(s)
- Sotiria Palioura
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christopher R Henry
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Guillermo Amescua
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eduardo C Alfonso
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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25
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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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Abstract
Advanced purulent corneal ulcer, as well as abscess, is a serious vision-threatening condition notable for its fulminant course and possible loss of the eye due to endophthalmitis. Its leading causes, pathogenesis, and classifications are described and analyzed in this paper.
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Affiliation(s)
- Evg A Kasparova
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - Evg A Kasparova
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
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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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Freitas DD. Penetrating Keratoplasty in Herpes Simplex Disease. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00134-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bacterial Keratitis After Manual Descemet Stripping Endothelial Keratoplasty—A Different Pathophysiology? Eye Contact Lens 2010; 36:62-5. [DOI: 10.1097/icl.0b013e3181c8133d] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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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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Akova YA, Dabil H, Kavalcioglu O, Duman S. Clinical features and keratoplasty results in keratoconus complicated by acute hydrops. Ocul Immunol Inflamm 2009. [DOI: 10.1076/0927-3948(200006)821-0ft101] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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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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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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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-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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Srinivasan S, McAllum P, Poutanen SM, Slomovic AR. Bilateral simultaneous Achromobacter xylosoxidans keratitis following penetrating keratoplasty. J Cataract Refract Surg 2007; 32:2149-52. [PMID: 17138001 DOI: 10.1016/j.jcrs.2006.06.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Accepted: 06/20/2006] [Indexed: 10/23/2022]
Abstract
We report a case of severe bilateral simultaneous Achromobacter xylosoxidans keratitis following penetrating keratoplasty (PKP) in a patient with graft-versus-host disease. The predisposing factors, clinical features, treatment options, and final visual outcome are reviewed. To our knowledge, this is the first report of bilateral A xylosoxidans keratitis following PKP.
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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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Wright TM, Afshari NA. Microbial keratitis following corneal transplantation. Am J Ophthalmol 2006; 142:1061-2. [PMID: 17157593 DOI: 10.1016/j.ajo.2006.06.051] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2005] [Revised: 06/08/2006] [Accepted: 06/20/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To study clinical and microbiologic characteristics of corneal infections following penetrating keratoplasty (PK). DESIGN Retrospective case series. METHODS Medical records of patients who presented to Duke University Eye Center from January 1, 1999 to July 1, 2005 with microbial keratitis after PK were reviewed. RESULTS Forty-four corneal graft infections were reviewed. Mean interval between PK and infection was 26.3 months. Associated conditions included broken or loose sutures (10, 22.7%) and topical corticosteroids (34, 77.3%). Staphylococcal (12, 20.7%) and Pseudomonal (7, 12.1%) species were common pathogens, and fungal species accounted for eight (18.2%) infections. Twelve patients (27.3%) had polymicrobial infections. Thirteen patients (29.5%) underwent repeat PK. Mean postinfection visual acuity at last follow-up was 20/400. CONCLUSIONS Microbial infections within corneal grafts can occur anytime in the postoperative course and are associated with broken sutures and the use of topical corticosteroids. The diversity of pathogenic organisms, antibiotic resistance, and the potential for poor outcomes supports aggressive management of these infections.
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Affiliation(s)
- Tarra M Wright
- Duke University Eye Center, Duke University Medical Center, Durham, North Carolina 27710, USA
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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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Abstract
AIM To present seven eyes of suspected donor to host transmitted Pseudomonas sp corneal graft infection after corneal and scleral graft leading to corneal melting within 24 hours, in a span of 10 months. METHODS Case series. Seven eyes, operated for either penetrating or lamellar keratoplasty or scleral patch graft for different indications and which developed massive corneal/corneoscleral infection within 24 hours, were studied prospectively. RESULTS Pseudomonas aeruginosa, resistant to almost all antibiotics except polymyxin B in all and vancomycin in two, was identified as the causative organism from all the specimens obtained from the infected graft. CONCLUSION Post-keratoplasty infection is a disaster. The source of early infection is invariably iatrogenic. Use of empirical antibiotics in the media is not always sufficient to prevent such infection. Thus, measures must be taken in the form of strict maintenance of asepsis and revision of antibiotics added to the storage medium. Further, early recognition and energetic therapy for such infection could reduce the ophthalmic morbidity.
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Affiliation(s)
- A Panda
- Dr. Rajendra Prasad Centre of Ophthalmic Sciences, DII/36, AIIMS, New Delhi-110029, India.
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Sukhija J, Jain AK. Outcome of Therapeutic Penetrating Keratoplasty in Infectious Keratitis. Ophthalmic Surg Lasers Imaging Retina 2005. [DOI: 10.3928/1542-8877-20050701-09] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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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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Chen WL, Wu CY, Hu FR, Wang IJ. Therapeutic penetrating keratoplasty for microbial keratitis in Taiwan from 1987 to 2001. Am J Ophthalmol 2004; 137:736-43. [PMID: 15059714 DOI: 10.1016/j.ajo.2003.11.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2003] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the surgical outcomes of therapeutic penetrating keratoplasty (PKP) and its role in the management of microbial keratitis. DESIGN Interventional case series. METHODS We retrospectively performed a chart review of the hospital records of all 151 patients undergoing therapeutic PKP for culture-proven microbial keratitis at the National Taiwan University Hospital during a 14 year-period (1987-2001). Patients were divided into three categories: (1) bacterial keratitis; (2) fungal keratitis; and (3) acanthamoebic keratitis. Each of the following criteria was evaluated: (1) graft clarity 1 month and 1 year postoperatively; (2) cure of the disease; and (3) anatomical success rate. RESULTS A total of 108 therapeutic PKP met the criteria. Therapeutic PKP eradicated the infection in 37/41 of patients with bacterial keratitis, 36/52 of patients with fungal keratitis, and 13/15 of patients with acanthamoebic keratitis. 22/32 of grafts of bacterial keratitis, 20/39 of fungal keratitis, and 11/14 of acanthamoebic keratitis remained clear at 1 year postoperatively. A higher percentage of graft clarity at 1 year postoperatively was achieved in all three categories when grafts were 8.5 mm or less compared with larger grafts. All five patients with secondary endophthalmitis observed at the time of therapeutic PKP experienced a progression of infection despite aggressive surgical treatment, and had to be enucleated. CONCLUSIONS Therapeutic PKP is valuable in the management of microbial keratitis that is unresponsive to medical therapy. A higher percentage of clear graft was found when grafts were smaller in all three categories. Surgical results are worse for patients with fungal keratitis, regardless of graft clarity, anatomical success, or infection eradication rate.
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Affiliation(s)
- Wei-Li Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
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Bourcier T, Touzeau O, Thomas F, Chaumeil C, Baudrimont M, Borderie V, Laroche L. Candida parapsilosis keratitis. Cornea 2003; 22:51-5. [PMID: 12502949 DOI: 10.1097/00003226-200301000-00012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To present clinical, microbiologic, and histopathologic features of keratitis due to Candida parapsilosis. METHODS Clinicomicrobiologic evaluation of four patients (four eyes) with culture-proven C. parapsilosis keratitis. The patients were evaluated for symptoms, visual acuity, clinical observations, microbiologic examination of corneal scrapings, and pathologic examination of corneal buttons. RESULTS Three cases were observed after penetrating keratoplasty, and one case occurred after inhalation of corticosteroids. Clinical presentation of C. parapsilosis keratitis showed a great diversity. There was one case of crystalline keratopathy and three cases of suppurative corneal infiltrate. Histopathology of corneal buttons showed interlamellar accumulations of yeast. Medical treatment included topical amphotericin B and systemic triazoles. Penetrating keratoplasty was required in three patients. CONCLUSION Risk factors for C. parapsilosis keratitis may include corticosteroid use and prior corneal transplantation. The prognosis of C. parapsilosis keratitis with antifungal and surgical therapy may vary from good visual outcome to intraocular extension with phthisis bulbi.
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