Microbial Keratitis After Penetrating Keratoplasty

Sun, Jen-Pin; Chen, Wei-Li; Huang, Jen-Shang; Hou, Yu-Chih; Wang, I‐Jong; Hu, Fung‐Rong

doi:10.1016/j.ajo.2017.03.022

Cited by 30 publications

(38 citation statements)

References 20 publications

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“…Our analysis shows a graft infection risk of 4.77%, which is in concordance with other reports from the literature. Most reports within the literature suggest an infection rate between 1.76% and 7.4%, 6 , 10 , 24 – 26 but centres from the developing world report rates as high as 25%. 27…”

Section: Discussionmentioning

confidence: 99%

“…Although this study was not designed to assess the effect of certain risk factors for graft infections, a significant proportion of patients were using glaucoma medications, which have been shown by other authors to increase the risk of graft failure post-infection. 26 Ocular surface disease has been shown to occur as a result of preserved anti-glaucoma medications, with a reduction in superficial epithelial cells suggested as one mechanism for resultant epithelial toxicity. 36 Benzalkonium chloride of 0.001% or lower appears to be the least toxic to the ocular surface.…”

Section: Discussionmentioning

confidence: 99%

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<p>Microbial Keratitis in Corneal Transplants: A 12-Year Analysis</p>

Griffin

Walkden

Okonkwo

et al. 2020

OPTH

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Purpose To investigate the frequencies, trends, and in vitro drug susceptibilities of the causative pathogens in corneal transplant microbial infections in Manchester Royal Eye Hospital. Methods Corneal scrape results recorded by the microbiology service between 2004 and 2015 were extracted from an established database. This microbiological data was matched with a separate database of all corneal transplant procedures performed in our centre over this time period. Patient records were examined to collect specific patient data and to confirm the diagnosis of microbial keratitis. Results A total of 1508 grafts had been performed at our centre in this period. 72 episodes of graft microbial keratitis were identified from 66 eyes that had undergone keratoplasty procedures. Mean age was 56, and 51% of subjects were male. Ninety-three percent of microbial keratitis episodes occurred in penetrating keratoplasty procedures and 6% in deep anterior lamellar keratoplasty procedures. No endothelial grafts presented with infections throughout this time period. Of the 79 organisms identified, 73% were gram positive, 23% gram negative and 4% fungi. With regard to gram-positive organisms, vancomycin and gentamicin showed 100% and 91% susceptibility, respectively. Ofloxacin had a resistance rate of 13.7%. In terms of gram-negative organisms, gentamicin and chloramphenicol showed 100% sensitivity, with cefuroxime showing 69%. Resistance rates were less than 15% in all tested gram-negative antimicrobials. Conclusion This paper describes the largest collection of corneal transplant infections identified within the UK. This finding may aid clinicians in predicting possible causative organisms for microbial keratitis and aid antibiotic choice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

<p>Microbial Keratitis in Corneal Transplants: A 12-Year Analysis</p>

Griffin

Walkden

Okonkwo

et al. 2020

OPTH

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“…A variety of factors may play a role in the development of MK after penetrating keratoplasty. 2 , 8 , 10 Gram-positive bacteria in the ocular surface flora, most frequently Staphylococcus species, have been identified as the most common causative agents in MK after PK. 3 , 6 Gram-negative and fungal keratitis are less common than those caused by gram-positive bacteria.…”

Section: Introductionmentioning

confidence: 99%

Distribution of Microbial Keratitis After Penetrating Keratoplasty According to Early and Late Postoperative Periods

Özalp

Atalay

Köktaş³

et al. 2020

tjo

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Objectives: The aim of this study was to investigate the distribution of microbial agents in the early and late postoperative periods in patients with microbial keratitis (MK) after penetrating keratoplasty (PK). Materials and Methods: The records of 36 patients who were clinically diagnosed as having MK after PK were retrospectively reviewed. Culture results were obtained from microbiology records and the organisms that were produced were noted. A case was deemed as viral keratitis based on the clinical appearance, negative cultures, and response to antiviral treatment. Keratitis development times were evaluated in 2 categories: early (within the first year) and late (after year 1) postoperative period. Mann-Whitney U and Kruskal-Wallis tests were used to compare numerical variables that did not show normal distribution and chi-square test was used to compare categorical variables. Results: The majority of MK cases were of bacterial origin (55.5%, n=20), followed by viral (41.7%, n=15) and fungal (2.8%, n=1). Of the 15 cases of early postoperative MK, 10 were bacterial, 4 were viral, and 1 was fungal; however, among cases of late postoperative MK, 10 were bacterial and 11 were viral. The majority (65%) of early and late bacterial infections were caused by gram-positive strains (most commonly staphylococci). Gram-positive bacteria caused keratitis significantly earlier than gram-negative bacteria (p=0.037). Viral and gram-negative bacterial MK was more frequent in the late postoperative period, but the difference was not statistically significant. Conclusion: In our study, bacterial keratitis was more common in post-keratoplasty MK than viral and fungal keratitis. Gram-positive bacteria were the most common causative agents. The increased incidence of gram-negative bacterial agents and viral keratitis in the late postoperative period can be explained by long-term topical steroid use.

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“…Many reports have documented that prior eye surgery can constitute a risk factor for eye infection, with rates ranging from 1% to 35%. 5 , 13 In this study, no association was found between previous eye surgery and keratitis occurrence, probably due to the small number of surgical procedures performed by patients with keratitis (4/64); an equal number of surgeries was also performed in the control group (4/47).…”

Section: Discussionmentioning

confidence: 51%

Non-viral microbial keratitis in adults: clinical and laboratory aspects

Cury

Chang

Pontes

2018

Brazilian Journal of Microbiology

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This study compares patients with and without non-viral microbial keratitis in relation to sociodemographic variables, clinical aspects, and involved causative agent. Clinical aspects, etiology and therapeutic procedures were assessed in patients with and without keratitis that were diagnosed in an Eye Care Center in Campo Grande, MS, Brazil. Patients were divided into two groups: (a) cases: 64 patients with non-viral microbial keratitis diagnosed at biomicroscopy; and (b) controls: 47 patients with other eye disorders that were not keratitis. Labor activity related to agriculture, cattle raising, and contact lens use were all linked to keratitis occurrence (p<0.005). In patients with keratitis, the most common symptoms were pain and photophobia, and the most frequently used medicines were fourth-generation fluoroquinolones (34.4%), amphotericin B (31.3%), and natamycin (28.1%). Microbial keratitis evolved to corneal perforation in 15.6% of cases; transplant was indicated in 10.9% of cases. Regarding the etiology of this condition, 23 (42.2%) keratitis cases were caused by bacteria (Pseudomonas aeruginosa, 12.5%), 17 (39.1%) by fungi (Fusarium spp., 14.1% and Aspergillus spp., 4.7%), and 4 (6.3%) by Acanthamoeba. Patients with keratitis present with a poorer prognosis. Rapid identification of the etiologic agent is indispensable and depends on appropriate ophthalmological collection and microbiological techniques.

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Microbial Keratitis After Penetrating Keratoplasty

Cited by 30 publications

References 20 publications

<p>Microbial Keratitis in Corneal Transplants: A 12-Year Analysis</p>

<p>Microbial Keratitis in Corneal Transplants: A 12-Year Analysis</p>

Distribution of Microbial Keratitis After Penetrating Keratoplasty According to Early and Late Postoperative Periods

Non-viral microbial keratitis in adults: clinical and laboratory aspects

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