title: Therapeutic dilemma in fungal keratitis: administration of steroids for immune rejection early after keratoplasty.
abstract: OBJECTIVE
  To investigate the timing and dosage of topical corticosteroid use after keratoplasty for fungal keratitis, and to evaluate the results with regard to anterior segment inflammation, immune rejection, and fungal recurrence.
  
  
  METHODS
  This prospective observational study included a total of 244 patients (244 eyes) who underwent penetrating keratoplasty (PK, 118 patients) or lamellar keratoplasty (LK, 126 patients) for fungal keratitis at the Shandong Eye Hospital between January 2009 and April 2014. Topical administration of steroid eye drops was initiated at 1 week after surgery. Changes in ocular inflammation before and after steroid use, percentages of eyes with fungal recurrence and immune rejection, and the relationship between the timing of local administration of steroids and therapeutic anti-inflammatory effects after keratoplasty were evaluated. The follow-up period was 6 months.
  
  
  RESULTS
  Anterior segment inflammation was aggravated within 1 week after surgery, with ocular pain, photophobia, redness, and tearing, but was controlled at 7.51 ± 1.76 days after steroid use. Fungal keratitis recurred in three eyes (1.23 %) at 3 to 5 days after administration of corticosteroids, including two eyes receiving PK and one eye receiving LK. Recurrence was controlled with antifungal medications. Allograft rejection occurred in eight (6.78 %) of 118 patients treated by PK, but did not occur in patients treated by LK.
  
  
  CONCLUSIONS
  Initiating the use of topical corticosteroids in patients with fungal keratitis 1 week after keratoplasty can aid in rapid control of anterior segment inflammation and reduction of immune rejection, with no increase in the rate of fungal recurrence.
authors.affiliation: From Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, China.
authors.forename: Ting
authors.initials: T
authors.lastname: Wang
authors.affiliation: From Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, China.
authors.forename: Suxia
authors.initials: S
authors.lastname: Li
authors.affiliation: From Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Gao
authors.affiliation: From Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, China. weiyunshi@163.com.|Shandong Eye Hospital, 372 Jingsi Road, Jinan, 250021, People's Republic of China. weiyunshi@163.com.
authors.forename: Weiyun
authors.initials: W
authors.lastname: Shi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage*; D003657:Decision Making; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006085:Graft Survival; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D011446:Prospective Studies; D012008:Recurrence; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D005938:Glucocorticoids; D009883:Ophthalmic Solutions
keywords: Corticosteroid; Fungal keratitis; Fungal recurrence; Immune rejection; Keratoplasty