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A 7-year review of clinical characteristics, predisposing factors and outcomes of postkeratoplasty infectious keratitis: the Nottingham infectious keratitis study.

Authors :
Zun Zheng Ong
Thai Ling Wong
Suresh, Lakshmi
Hammoudeh, Yasmeen
Lister, Michelle
Said, Dalia G.
Dua, Harminder S.
Ting, Darren S. J.
Source :
Frontiers in Cellular & Infection Microbiology; 2023, p1-12, 12p
Publication Year :
2023

Abstract

Background/objectives: Post-keratoplasty infectious keratitis (PKIK) is a unique sight-threatening clinical entity which often poses significant therapeutic challenges. This study aimed to examine the clinical presentation, risk factors, management, and clinical outcomes of PKIK. Methods: This was a retrospective study of all patientswho presented to the Queen's Medical Centre, Nottingham, with PKIK between September 2015 and August 2022 (a 7-year period). Relevant data on types of keratoplasty, clinical presentations, causative microorganisms, management, and outcome were analyzed. Results: Forty-nine PKIK cases, including four cases of interface infectious keratitis, were identified during the study period. The most common graft indications for PKP, DALK and EK were failed grafts (9, 37.5%), keratoconus (6, 54.5%) and Fuchs endothelial corneal dystrophy (FECD; 8, 57.1%), respectively. Staphylococcus spp. were the most commonly identified organisms (15, 50.0%). Bullous keratopathy (18, 36.7%), ocular surface disease (18, 36.7%), and broken/loose sutures (15, 30.6%) were the most common risk factors. Concurrent use of topical steroids was identified in 25 (51.0%) cases. Of 31 functioning grafts at presentation, 12 (38.7%) grafts failed at final follow-up with 15 (48.4%) patients retaining a CDVA of =1.0 logMAR. The overall estimated 5-year survival rate post-PKIK was 55.9% (95% CI, 35.9%-75.9%), with DALK having the highest survival rate [63.6% (95% CI, 28.9%-98.3%)], followed by EK [57.1% (95% CI, 20.4%-93.8%)] and PKP [52.7% (95% CI, 25.1%-80.3%)], though no statistical difference was observed (p=0.48). Conclusions: PKIK represents an important cause of IK and graft failure. Bullous keratopathy, OSD and suture-related complications are the commonest risk factors, highlighting the potential benefit of prophylactic topical antibiotics (for unhealthy ocular surface) and early suture removal (where possible) in reducing the risk of PKIK. Graft survival may be higher in lamellar keratoplasty following PKIK but larger studies are required to elucidate this observation. [ABSTRACT FROM AUTHOR]

Subjects

Subjects :
CORNEAL dystrophies
KERATITIS

Details

Language :
English
ISSN :
22352988
Database :
Complementary Index
Journal :
Frontiers in Cellular & Infection Microbiology
Publication Type :
Academic Journal
Accession number :
171933721
Full Text :
https://doi.org/10.3389/fcimb.2023.1250599