Current Concepts in the Management of Unique Post-keratoplasty Infections

Schallhorn, Julie M.; Rose‐Nussbaumer, Jennifer

doi:10.1007/s40135-015-0075-7

Cited by 11 publications

(5 citation statements)

References 50 publications

(73 reference statements)

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“…The peak time for infectious keratitis after EK appears to be 1-3 months after surgery and the range for time of infection varies from as early as three days to late-onset after 16 months after DSEK. [9][10][11] The median time for the development of interface infection is described as 28 days with a range of 1 to 120 days. 3 We noticed infections restricted to interface only in the early-onset group.…”

Section: Discussionmentioning

confidence: 99%

Keratitis following descemet's stripping endothelial keratoplasty (DSEK): Clinical features and outcome in early vs late presentation

Soni

Das

Alluri

et al. 2022

European Journal of Ophthalmology

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Objective To compare the clinical presentation, risk factors, causative organisms, and final outcome of early- and late- onset microbial keratitis following Descemet's Stripping Endothelial Keratoplasty (DSEK). Materials And Methods In a retrospective, comparative, case series, twenty-three (10 early-onset keratitis, 13 late-onset keratitis) cases were included for analysis from a single centre tertiary eye care setup. Data about demography, indication, clinical features, and outcome were collected for both the groups. Comparison of clinical presentation, risk factors, microbiology and final outcome were carried out. Results The most common indication was failed graft. While all patients with late-onset keratitis presented with ulcerative keratitis, 60% of early-onset keratitis presented with ulcerative keratitis. Four patients in the early-onset group had interface keratitis. Associated endophthalmitis was more in the early-onset compared to the late-onset group. Early-onset interface keratitis cases are mostly associated with donor-related infection. Gram-positive bacteria were the most common organisms isolated from both early- and late- onset infection. Major surgical procedures in both early- and late- onset keratitis included lenticule removal ( n = 4) and therapeutic penetrating keratoplasty ( n = 5). Conclusions Failed graft is a major risk factor in post-DSEK keratitis. Interface keratitis and endophthalmitis are commonly observed in early-onset keratitis. A majority of the patients need surgical intervention.

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Section: Discussionmentioning

confidence: 99%

Keratitis following descemet's stripping endothelial keratoplasty (DSEK): Clinical features and outcome in early vs late presentation

Soni

Das

Alluri

et al. 2022

European Journal of Ophthalmology

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“…Reports for keratitis range from 3 days to 16 months, with a peak time of 1-3 months after surgery. Bacterial and fungal infections appear to be equal in prevalence [2]. A retrospective case series of 3950 eyes which underwent DMEK reported early and late fungal interface keratitis in 6 eyes (0.15 %) [5].…”

Section: Discussionmentioning

confidence: 99%

“…Compared to traditional penetrating keratoplasty, the replacement of only the diseased endothelium in Descemet membrane endothelial keratoplasty (DMEK) has been shown to result in better visual outcomes, shorter recovery times, and less postoperative complications [1]. However, the resulting interface is a new potential site where infectious microorganisms may be sequestered [2]. Bacterial keratitis is routinely managed with topical medications because high minimum inhibitory concentrations can usually be attained in these cases, hence, an alternate method of drug delivery is rarely necessary [3].…”

Section: Introductionmentioning

confidence: 99%

Post-DMEK Bacterial Interface Keratitis Treated with Intrastromal and Intracameral Antibiotics

Janeschitz‐Kriegl

Dimacali²,

Sagri³

et al. 2020

Klin Monatsbl Augenheilkd

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“…Research efforts to improve surgical procedures and graft survival have led to excellent results in terms of patient outcomes . However, the risk of post‐keratoplasty infection is still a serious concern and it may be, at least in part, due to the transplantation of contaminated corneas . Moreover, any of the steps, from tissue procurement to release for corneal grafting, may pose concerns in terms of potential tissue contamination .…”

Section: Introductionmentioning

confidence: 99%

Monitoring the microbial contamination of donor cornea during all preservation phases: A prospective study in the Eye Bank of Rome

Vignola

Giurgola²,

Gisoldi

et al. 2019

Transplant Infectious Dis

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Background In most European eye banks, human donor corneas are microbiologically tested after storage in organ culture conditions, and the tissues that are free of contamination are distributed for transplantation. In this prospective study, 100 donor corneas were tested for microbial contamination after cold storage, corneal culture and corneal deswelling at the Eye Bank of Rome. Methods Samples of cold storage medium (EUSOL‐C), corneal culture medium (TISSUE‐C) and deswelling medium (CARRY‐C) were tested after three, seven and one days of corneal storage, respectively. The CARRY‐C medium, used to transport the cornea to the operation theatre, was retested 1 day after transplantation. The TISSUE‐C and CARRY‐C media were also tested after removing antimicrobial and antifungal agents using a dedicated device. Results We found 67% of the EUSOL‐C samples were contaminated mainly by Staphylococcus spp, 14% of TISSUE‐C media were contaminated by bacteria and fungi and 3% of CARRY‐C media by Staphylococcus spp The analysis performed after removing the antimicrobial and antifungal agents showed growth in three additional TISSUE‐C samples (S viridans, S haemolyticus and E faecalis) and one CARRY‐C (S cerevisiae and P acnes). Conclusion Tissue contamination was unexpectedly high on arrival to the eye bank, indicating the need to review and update decontamination procedures during tissue recovery, and renew training for the recovery teams. Storing donor corneas in organ culture conditions significantly reduced the microorganism burden. Using devices to remove antimicrobial and antifungal agents from samples before testing can increase the sensitivity of the standard microbiological method, and thus help further reduce the risk of microbial transmission.

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Current Concepts in the Management of Unique Post-keratoplasty Infections

Cited by 11 publications

References 50 publications

Keratitis following descemet's stripping endothelial keratoplasty (DSEK): Clinical features and outcome in early vs late presentation

Keratitis following descemet's stripping endothelial keratoplasty (DSEK): Clinical features and outcome in early vs late presentation

Post-DMEK Bacterial Interface Keratitis Treated with Intrastromal and Intracameral Antibiotics

Monitoring the microbial contamination of donor cornea during all preservation phases: A prospective study in the Eye Bank of Rome

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