Interface infection after descemet stripping automated endothelial keratoplasty: outcomes of therapeutic keratoplasty.

Abstract

PURPOSE:

The aim of this study was to evaluate the visual outcomes and graft survival rate after therapeutic keratoplasty performed for interface infection after Descemet stripping automated endothelial keratoplasty (DSAEK).

METHODS:

This is a retrospective, interventional case series. The study population comprised 7 patients who developed unilateral post-DSAEK interface infection unresponsive to conservative treatment, with or without graft exchange, and were treated with penetrating keratoplasty (PK), 9 to 9.5 mm in diameter, with en bloc excision of the recipient cornea and DSAEK graft. The main outcome measures included best spectacle-corrected visual acuity, refractive error, histological examination, reinfection, and rejection and graft survival rates.

RESULTS:

Interface infection was diagnosed in 10 (0.92%) of 1088 eyes that underwent DSAEK at our institution between 2005 and 2013. Seven of 10 eyes (0.64% of the total) were unresponsive to conservative treatment and underwent therapeutic keratoplasty. Candida and Staphylococcus species were identified in 3 cases each, and Nocardia species was identified in 1 case. With a mean post-PK follow-up of 25.4 months (range 4-60 months), no recurrence of infection was seen in any eye, and 5 of 7 PK grafts remained clear. Best spectacle-corrected visual acuity was 20/20 in 2 eyes, better than 20/50 in 4 eyes, and 20/100 or worse in 3 eyes, in 2 of which the graft had failed within 1 year of performing the PK.

CONCLUSIONS:

Therapeutic keratoplasty is instrumental in eliminating interface infection after DSAEK, possibly leading to excellent visual outcomes with a relatively high graft survival rate.

• Authors: Yoav Nahum, Cataldo Russo, Silvana Madi, Massimo Busin
• Journal: Cornea (Cornea) Vol. 33 Issue 9 Pg. 893-8 (Sep 2014) ISSN: 1536-4798 [Electronic] United States
• PMID: 25062335 (Publication Type: Case Reports, Journal Article)

Topics

• Aged
• Aged, 80 and over
• Corneal Diseases (diagnosis, microbiology, surgery)
• Descemet Stripping Endothelial Keratoplasty (adverse effects)
• Endothelium, Corneal (microbiology)
• Eye Infections, Bacterial (diagnosis, microbiology, surgery)
• Eye Infections, Fungal (diagnosis, microbiology, surgery)
• Female
• Graft Survival
• Humans
• Keratoplasty, Penetrating
• Male
• Middle Aged
• Retrospective Studies
• Surgical Wound Infection (diagnosis, microbiology, surgery)
• Treatment Outcome
• Visual Acuity (physiology)