Clinical study on the recurrence of fungal keratitis after lamellar keratoplasty

Abstract

To study the characters, diagnosis, treatment and risk factors of the recurrence of fungal keratitis after lamellar keratoplasty (LKP). In this nonrandomized retrospective case series, two hundred and eighteen cases of fungal keratitis were undertaken partial LKP from January 1998 to July 2005. The case history was inquired in detail preoperatively. A trephine with diameter 0. 5 mm larger than the area of fungal infection was used to incise the lamellar corneal ulcer, and the hyphae of some cases were inspected with microscope during the operation. The recurrence of fungal keratitis was observed after the surgery. Medical treatment and/or operation were used in the management of recurrent cases. The risk factors for the recurrence of fungal keratitis after LKP, such as fungal species, glucocorticoid or immunosuppressant therapy, hypopyon or endothelial plague, were also analyzed. Seventeen cases (7.80%) recurred within 2 weeks after surgery and mainly (15 cases) within 1 week. The recurrence displayed with increased local irritation and hypha infiltration on recipient LKP bed. All recurrent fungal infections were controlled by performing penetrating keratoplasty (PKP). Risk factor analysis: (1) The recurrent rate of Aspergillus infection (19.23%) was higher than that in Fusarium infection (5.63%) (P = 0.0323). (2) The recurrence rate of cases treated with glucocorticoid or immunosuppressant preoperatively (21.70%) was much higher than that in non-treated cases (6.15%) (P =0.0219). (3) The recurrence rate of cases with hypopyon or endothelial plague preoperatively (17.02%) was much higher than that without these signs (5.26%) (P = 0.0134). The recurrence of fungal keratitis after LKP occurs mainly within the 1st week. Aspergillus infection, glucocorticoid or immunosuppressant therapy, hypopyon or endothelial plague are the risk factors for LKP.