A comparative study on clinical outcomes of penetrating keratoplasty for diabetes versus non-diabetes fungal keratitis patients

Abstract

Background Fungal keratitis is one of the main leading cause of blindness in China, the incidence of which is increasing year by year, while fungal keratitis with diabetes mellitus (DM) also has an increasing trend.Penetrating keratoplasty (PKP) is an effective treatment for fungal keratitis with high risks, but the study on clinical effect of diabetes mellitus on PKP is still relatively scarce. Objective The clinical data of 92 cases of fungal keratitis with DM and 106 cases of fungal keratitis without systemic disease who underwent PKP were retrospectively reviewed, and the postoperative best corrected visual acuity (BCVA), implant rejection, fungus recurrence, complicated cataract and secondary glaucoma were analyzed and compared. Results Moderate and severe infection were obtained in corneas of the two groups, the eye number distributions of different infection degree and Eurotium infection were not significantly different between the two groups (χ2=0.166, P=0.684). The eye number distributions of Eurotium infection had no statistical significance between the two groups(χ2=0.340, P=0.854). The eye number distributions of Fusarium and Candida infection were significantly different between the two groups (χ2=2.068, P=0.010; χ2=3.874, P=0.049) The BCVA of the 2 groups from 1 week to 2 years postoperative were all higher than preoperative.The numbers of patients whose BCVA>0.3 in fungal keratitis with DM group were significantly lower than those in the fungal keratitis without DM group in different time intervals after surgery (all at P 0.05). Conclusions Compared with fungal keratitis patients without DM, fungal keratitis patients with DM have lower visual improvement, higher rate of implant rejection, fungus recurrence and complicated cataract after PKP.DM is a risk factor of complications after PKP. Key words: Diabetes/complication; Keratoplasty, penetrating; Eye infections, fungal/surgery; Treatment outcomes; Retrospective studies