Abstract
Background: This study aimed to investigate the outcome of therapeutic penetrating keratoplasty (TPK) for medically-uncontrolled infectious keratitis, and to determine the factors associated with the recurrence of infection after TPK. Methods: A 10-year retrospective study of medically-uncontrolled infectious keratitis with positive culture results, who received TPK at a tertiary referral center in Korea was performed. Data collection included patient demographics, medical history, pre- and post-operative findings, surgical procedures, causative microorganisms, and visual acuities (VA). The primary outcome measure was the recurrence of infection after TPK, and the factors were compared between patients with and without recurrence. Results: A total of 19 patients (19 eyes) were analyzed, of which 6 eyes (31.6%) had infection recurrence at 21.6 ± 22.84 months after TPK. Recurrence occurred more frequently in the female sex (vs. male, p = 0.013) and in longer duration (>30 days) from infection onset to TPK (vs. ≤30 days, p = 0.025). Final best-corrected-VA was poorer in patients with recurrence than those without (LogMAR 1.60 ± 0.97 vs. 2.40 ± 0.46, p = 0.026). Evisceration was performed in 2 out of 6 patients with recurrence (33.3%), while none was performed in those without recurrence (p = 0.028). Conclusion: Infection recurrence after TPK was 31.6%. Given the poor outcome of TPK in eyes with recurrence, close monitoring and intensive treatment are required post-TPK.
Highlights
The incidence of infectious keratitis is increasing in developed countries, with the rise of contact lens use, corneal surgery, or ocular surface disorders, including dry eye disease [1,2,3]
In a recent Asian multicenter study, the Fusarium species (18.3%) was reported to be the most common microorganism isolated from infectious keratitis, followed by Pseudomonas aeruginosa (10.7%) [3], but more than half of the cases analyzed in the study were from India
We investigated the outcome of therapeutic penetrating keratoplasty (TPK), which was performed in Korean patients with infectious keratitis that was unresponsive to maximal fortified antimicrobial combinations from the following perspectives—(1) eradication of infection, (2) maintenance of globe integrity, (3) achievement of graft clarity, and (4) visual rehabilitation
Summary
The incidence of infectious keratitis is increasing in developed countries, with the rise of contact lens use, corneal surgery, or ocular surface disorders, including dry eye disease [1,2,3]. Recent studies showed the efficacy of collagen cross-linking as an adjunctive therapy to antimicrobial treatment for infectious keratitis [10] Despite these significant advances in diagnostic and therapeutic modalities, there are still cases of infectious keratitis that do not respond to maximal medical therapy and instead progress to corneal perforation or endophthalmitis. In these refractive cases, therapeutic penetrating keratoplasty (TPK) was used and was reported to eliminate infection in 69–100% of infectious keratitis [11]. This study aimed to investigate the outcome of therapeutic penetrating keratoplasty (TPK) for medically-uncontrolled infectious keratitis, and to determine the factors associated with the recurrence of infection after TPK. Given the poor outcome of TPK in eyes with recurrence, close monitoring and intensive treatment are required post-TPK
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