Interface infectious keratitis after anterior and posterior lamellar keratoplasty. Clinical features and treatment strategies. A review

Abstract

Interface infectious keratitis (IIK) is a novel corneal infection that may develop after any type of lamellar keratoplasty. Onset of infection occurs in the virtual space between the graft and the host where it may remain localised until spreading with possible risk of endophthalmitis. A literature review identified 42 cases of IIK. Thirty-one of them occurred after endothelial keratoplasty and 12 after deep anterior lamellar keratoplasty. Fungi in the form of Candida species were the most common microorganisms involved, with donor to host transmission of infection documented in the majority of cases. Donor rim cultures were useful to address the infectious microorganisms within few days after surgery. Due to the sequestered site of infection, medical treatment, using both topical and systemic antimicrobials drugs, was ineffective on halting the progression of the infection. Injection of antifungals, right at the graft–host interface, was reported successful in some cases. Spreading of the infection with development of endophthalmitis occurred in five cases after Descemet stripping automated endothelial keratoplasty with severe sight loss in three cases. Early excisional penetrating keratoplasty showed to be the treatment with the highest therapeutic efficacy, lowest rate of complications and greater visual outcomes.

Donor‐to‐host transmission of infection: contrasting outcomes of lamellar and penetrating keratoplasty

“…Recent evidence reported an increasing trend in the incidence of fungal infection after endothelial keratoplasty compared with penetrating keratoplasty (PK), although neither observation reached statistical significance . The main reason is the creation in lamellar techniques of a donor–host interface that provides a hypoxic sequestered environment for microorganisms to thrive protected from the host immune response . We describe herein the contrasting outcomes of two patients who received tissues from the same donor contaminated with Candida albicans : the first patient underwent Descemet’s stripping automated endothelial keratoplasty (DSAEK), while the second one underwent PK.…”

Multi-drug resistant Enterococcus faecium in late-onset keratitis after deep anterior lamellar keratoplasty

“…Diagnosis and treatment of interface keratitis is a challenge, due to the deep stromal location that precludes access for microbial examination and topical drug penetration in the site of infection. [2] We describe herein the first case of Enterococcus faecium infection following DALK, successfully treated with targeted systemic therapy with Tigecycline and Linezolid associated with therapeutic PKP.…”

Acute interface infectious keratitis with multidrug resistant Klebsiella and Escherichia Coli following deep anterior lamellar keratoplasty

“…[ 1 2 ] Postoperative acute interface infectious keratitis (AIIK) following DALK is a rare, devastating, and potentially sight-threatening complication, mainly caused by Candida spp . [ 3 4 5 ] There are only three published reports about AIIK following DALK due to Klebsiella pneumoniae . [ 6 7 8 ] Gram-negative bacteria are common nosocomial pathogens, and sometimes corneas from hospitalized donors are contaminated.…”

“…[ 9 10 ] Since the exudates are trapped in the potential space between the donor cornea and host Descemet membrane (DM), surgical management in the form of therapeutic penetrating keratoplasty (TPK) is often required. [ 5 ]…”