title: Therapeutic penetrating keratoplasty in severe fungal keratitis using cryopreserved donor corneas.
abstract: OBJECTIVE
  To investigate whether cryopreserved donor cornea could be used for therapeutic penetrating keratoplasty (PKP) to eradicate the infection, obviate complications, and preserve anatomical integrity in severe fungal keratitis.
  
  
  METHODS
  In this retrospective, consecutive case series, 45 eyes of 45 patients with severe fungal keratitis, which exhibited anterior chamber collapse, corneal perforation, and/or large suppurative corneal infiltrate, received therapeutic PKP after removal of the infected corneal tissue, irrigation of the anterior chamber by 0.2% fluconazole solution, iris dissection of fibrinoid membrane, and iridectomy and therapeutic PKP using corneas cryopreserved at -20 degrees C.
  
  
  RESULTS
  Among 45 eyes, 39 eyes (86.7%) were successfully eradicated the fungal infection without recurrence and maintained their anatomical integrity without any complication. Four of 45 eyes (8.9%) showed postoperative rise of intraocular pressure, of which three were controlled with subsequent antiglaucoma surgeries, whereas one eye needed additional antiglaucoma medications. Two of 45 eyes (4.4%) were enucleated because of uncontrollable fungal infection and secondary retinal detachment, respectively. 23 eyes received subsequent optical PKP and, among them, 21 maintained clear corneal grafts and two suffered from graft failure due to allograft rejections.
  
  
  CONCLUSIONS
  Cryopreserved donor corneas are effective substitutes in therapeutic PKP to control severe fungal corneal infection and preserve the global integrity, and may offer additional advantages over conventional PKP in reducing allograft rejection, eradicating fungal infection during the postoperative period, and improving the success of optical PKP for visual rehabilitation.
authors.affiliation: Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, P R China. yaoyuf@mail.hz.zj.cn
authors.forename: Y-F
authors.initials: YF
authors.lastname: Yao
authors.forename: Y-M
authors.initials: YM
authors.lastname: Zhang
authors.forename: P
authors.initials: P
authors.lastname: Zhou
authors.forename: B
authors.initials: B
authors.lastname: Zhang
authors.forename: W-Y
authors.initials: WY
authors.lastname: Qiu
authors.forename: S C G
authors.initials: SC
authors.lastname: Tseng
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003315:Cornea; D015925:Cryopreservation / Q000379:methods*; D015821:Eye Infections, Fungal / Q000382:microbiology / Q000601:surgery*; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage; D006801:Humans; D007275:Injections, Intravenous; D017964:Itraconazole / Q000008:administration & dosage; D007634:Keratitis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D015948:Keratoplasty, Penetrating / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole; D015725:Fluconazole