title: Interface infection after descemet stripping automated endothelial keratoplasty: outcomes of therapeutic keratoplasty.
abstract: OBJECTIVE
  The aim of this study was to evaluate the visual outcomes and graft survival rate after therapeutic keratoplasty performed for interface infection after Descemet stripping automated endothelial keratoplasty (DSAEK).
  
  
  METHODS
  This is a retrospective, interventional case series. The study population comprised 7 patients who developed unilateral post-DSAEK interface infection unresponsive to conservative treatment, with or without graft exchange, and were treated with penetrating keratoplasty (PK), 9 to 9.5 mm in diameter, with en bloc excision of the recipient cornea and DSAEK graft. The main outcome measures included best spectacle-corrected visual acuity, refractive error, histological examination, reinfection, and rejection and graft survival rates.
  
  
  RESULTS
  Interface infection was diagnosed in 10 (0.92%) of 1088 eyes that underwent DSAEK at our institution between 2005 and 2013. Seven of 10 eyes (0.64% of the total) were unresponsive to conservative treatment and underwent therapeutic keratoplasty. Candida and Staphylococcus species were identified in 3 cases each, and Nocardia species was identified in 1 case. With a mean post-PK follow-up of 25.4 months (range 4-60 months), no recurrence of infection was seen in any eye, and 5 of 7 PK grafts remained clear. Best spectacle-corrected visual acuity was 20/20 in 2 eyes, better than 20/50 in 4 eyes, and 20/100 or worse in 3 eyes, in 2 of which the graft had failed within 1 year of performing the PK.
  
  
  CONCLUSIONS
  Therapeutic keratoplasty is instrumental in eliminating interface infection after DSAEK, possibly leading to excellent visual outcomes with a relatively high graft survival rate.
authors: *Department of Ophthalmology, "Villa Igea" Hospital, Forli, Italy; †Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forli, Italy; ‡Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel; §Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and ¶University of Alexandria, Alexandria, Egypt.
authors: Yoav
authors: Y
authors: Nahum
authors: Cataldo
authors: C
authors: Russo
authors: Silvana
authors: S
authors: Madi
authors: Massimo
authors: M
authors: Busin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003316:Corneal Diseases / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000009:adverse effects*; D004728:Endothelium, Corneal / Q000382:microbiology; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology