Microbial keratitis complicating penetrating keratoplasty.
A retrospective review of 68 consecutive episodes of microbial keratitis complicating 66 penetrating keratoplasties (PKs) showed major risk associations: suture-related problems (50%), contact lens wear (26%), previous herpes simplex infection (15%), graft failure (15%), and persistent epithelial defects (15%). Topical steroid (85%) and antibiotic (59%) usage were common iatrogenic factors. Half the infections occurred more than 1 year after grafting. Bacterial infections involving gram-positive organisms (59%) predominated, except for patients with extended-wear hydrophilic contact lenses, which usually involved gram-negative bacilli. The incidence of fungal infections (6%) was relatively low. Recommendations to minimize microbial keratitis include prompt attention to exposed, broken, or loose sutures, and preventive and therapeutic management of epithelial defects. The inadequacy of low-dose antibiotics in precluding microbial infection in many cases and the propensity to develop infections with resistant organisms suggest that guidelines for using postoperative and prophylactic topical antibiotics require reevaluation.
Fong
L P
LP
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston.
Ormerod
L D
LD
Kenyon
K R
KR
Foster
C S
CS
D016039:Corneal Transplantation; D003320:Corneal Ulcer / Q000209:etiology; D005260:Female; D006801:Humans; D007634:Keratitis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections; D013290:Streptococcal Infections; D013530:Surgical Wound Infection / Q000209:etiology*; D013536:Suture Techniques / Q000009:adverse effects