The Therapeutic Effect of Corneal Transplantation for Refractory Pseudomonas Aeruginosa Corneal Ulcer

Abstract

Purpose To observe the treatment outcome of corneal transplantation for advanced medically uncontrolled culture-proven pseudomonas aeruginosa corneal ulcer.Design Retrospective analysisSubjects and methods 26 patients (eyes) with refractory culture-positive pseudomonas aeruginosa corneal ulcer who failed to respond to drug therapy and underwent consecutive corneal transplant procedures in a hospital (2008.1-2018.8). Etiology, medical history, clinical features, surgical type, vision, recurrence, complications and treatment were recorded, and the relationship between postoperative recovery and selection of surgical method was analyzed.Results Of the 26 patients with pseudomonas aeruginosa corneal ulcer, 9 (34.6%) received penetrating keratoplasty (PKP) and 17 (65.4%) received lamellar keratoplasty (LKP). 22 patients (84.6%) obtained a successful outcome through one corneal transplantation. Of the 9 patients who received PKP, 1 patient having graft rejection 6 months after surgery (endothelial type) obtained successful outcome through adequate drug treatment., while 1 case received success by graft repair combined with amniotic membrane transplantation on the 5 months postoperatively for fungal corneal graft ulcer. In the 17 patients underwent LKP, 2 received a second successful lamellar corneal transplantation for corneal graft melting 2 months after the first surgery. In all the 26 patients, the corneal infection was effectively brought under control by corneal transplantation, and none of them had recurrent ulcers during at least 6months' follow-up. The visual acuity was significantly improved at the last follow-up compared with that before surgery. The postoperative visual acuity of patients underwent LKP was better than that of those who underwent PKP ( p =0.018).Conclusions Corneal transplantation can effectively treat refractory pseudomonas aeruginosa corneal ulcer worsening despite adequate medical treatment and improve eyesight. Compared with PKP, LKP can be the main surgical method to treat refractory pseudomonas aeruginosa corneal ulcer.