title: Endophthalmitis after penetrating keratoplasty.
abstract: OBJECTIVE
  To determine the incidence of endophthalmitis after penetrating keratoplasty (PK) and patient and donor risk factors.
  
  
  METHODS
  Retrospective cohort study using national transplant registry data.
  
  
  METHODS
  All corneal transplant recipients (n = 11 320) registered on the United Kingdom Transplant Registry undergoing their first PK between April 1999 and December 2006.
  
  
  METHODS
  Patients who developed endophthalmitis were identified on the transplant registry. In addition, cases where the fellow cornea from the same donor had been transplanted were included. Clinical information regarding donor and recipient characteristics, surgical details, and postoperative outcomes were collected and analyzed. In cases where endophthalmitis was reported, the diagnosis was verified by a follow-up supplementary questionnaire to the surgeon. Logistic regression was used to investigate differences in the factors associated with the development of endophthalmitis.
  
  
  METHODS
  Incidence of endophthalmitis and graft survival.
  
  
  RESULTS
  The overall incidence of endophthalmitis occurring after primary PK in the UK was 0.67%. The incidence of endophthalmitis occurring within 6 weeks of surgery was 0.16%. Graft survival after endophthalmitis was 27% (95% confidence interval, 16-38) at 5 years, with a mean best-corrected visual acuity of 1.13 (logarithm of the minimum angle of resolution) for surviving grafts. Factors associated with endophthalmitis were donor cause of death (infection), high-risk cases, and indication for corneal transplantation.
  
  
  CONCLUSIONS
  Endophthalmitis remains a serious issue, with those affected having reduced graft survival and poor visual outcomes. Management of the identified recipient and donor risk factors are important to reduce endophthalmitis risk. In particular, the increased incidence of endophthalmitis when the donor dies of infection requires further explanation and review of current donor eye retrieval and eye bank practices. The delayed presentation of endophthalmitis cases also raises questions regarding possible sequestration of microbes within the corneal tissue and the effect of antimicrobials in storage media.
authors.affiliation: St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom. Electronic address: jy_chen79@yahoo.com.au.
authors.forename: Jern Yee
authors.initials: JY
authors.lastname: Chen
authors.affiliation: Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom.
authors.forename: Mark N
authors.initials: MN
authors.lastname: Jones
authors.affiliation: Department of Ophthalmology, University Hospital Ayr, Ayr, Scotland.
authors.forename: Sathish
authors.initials: S
authors.lastname: Srinivasan
authors.affiliation: Department of Medical Microbiology, Royal Liverpool University Hospital, Liverpool, United Kingdom.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Neal
authors.affiliation: School of Clinical Sciences, University of Bristol, Bristol, United Kingdom.
authors.forename: W John
authors.initials: WJ
authors.lastname: Armitage
authors.affiliation: St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Kaye
mesh_terms: D000367:Age Factors; D015331:Cohort Studies; D009877:Endophthalmitis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D014792:Visual Acuity / Q000502:physiology