Bacterial keratitis after manual descemet stripping endothelial keratoplasty--a different pathophysiology?
OBJECTIVE
To report two cases of infective keratitis caused by Pseudomonas aeruginosa after manual descemet stripping endothelial keratoplasty (DSEK).


METHODS
Case report.


RESULTS
Case 1, a 65-year-old woman, presented with a central corneal infiltrate after manual DSEK for pseudophakic bullous keratopathy, 6 weeks before this presentation. Case 2, a 55-year-old woman, developed a paracentral infiltrate after 7 weeks of undergoing DSEK. Both cases demonstrated Pseudomonas aeruginosa. The risk factors were analyzed. Both the eyes were treated with ciprofloxacin (0.3%) eye drop, while topical dexamethasone (0.1%) was used additionally in the second case. Resolution occurred after 48 days (case 1) and 21 days (case 2), respectively. Although the DSEK failed in case 1, the graft is clear in case 2 at 3 months.


CONCLUSIONS
Microbial keratitis after DSEK is a new area of concern in the postoperative period, both in developed and in developing countries, with a poor impact on graft outcome. Surface-related factors may predispose to this condition, particularly in pseudophakic bullous keratopathy, countering the advantage gained from absence of suture-related infections common after conventional keratoplasty. The location of the ulcer may have an impact on outcome, as also the inflammatory status. Judicious use of topical steroids early in the course of the disease may improve the immediate graft survival.
Sengupta
Jayangshu
J
Cornea and Ocular Surface Disease Clinic, Priyamvada Birla Aravind Eye Hospital, Kolkata, India. jayansu@hotmail.com
Khetan
Archana
A
Saha
Suman
S
Ganguly
Alokesh
A
Pal
Dipanjan
D
D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage; D002939:Ciprofloxacin / Q000008:administration & dosage; D016039:Corneal Transplantation / Q000009:adverse effects* / Q000379:methods; D003886:Descemet Membrane / Q000473:pathology / Q000601:surgery*; D003907:Dexamethasone / Q000008:administration & dosage; D004728:Endothelium, Corneal / Q000637:transplantation*; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007634:Keratitis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D009883:Ophthalmic Solutions; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D014792:Visual Acuity
D000890:Anti-Infective Agents; D005938:Glucocorticoids; D009883:Ophthalmic Solutions; D002939:Ciprofloxacin; D003907:Dexamethasone