title: Asymptomatic Infection in Decompensated Full-Thickness Corneal Grafts Referred for Repeat Penetrating Keratoplasty.
abstract: OBJECTIVE
  We report a case series of asymptomatic infections affecting failed corneal grafts in patients referred for repeat penetrating keratoplasty (PK).
  
  
  METHODS
  In this retrospective, noncomparative, interventional case series, we reviewed the medical records of all repeat PK procedures performed at Villa Serena-Villa Igea private Hospitals (Forlì, Italy) between January 2011 and March 2016. Specifically, preoperative and postoperative slit-lamp examinations, and the results of histological and bacteriological examinations, were noted.
  
  
  RESULTS
  Fifty-three repeat PKs were performed in the study period. All patients were referred because of long-standing graft decompensation with stromal scars or surface irregularities, thus unsuitable for endothelial keratoplasty. None was referred because of presumed infection. Histological examination of the explanted buttons showed the presence of microorganisms of various types in 7 eyes. Cultures were positive in 4 of these cases and in one additional case Staphylococcus aureus was grown in culture, but was not seen in the histology specimen. None of the patients presented with unusual pain, tearing, or discomfort. Preoperative abnormal clinical findings included epithelial defect (n = 6), focal whitening of corneal stroma (n = 5), crystalline keratopathy (n = 1), and an elevated pigmented lesion (n = 1). After repeat PK, recurrence of the infection was seen in 5 of 7 (71%) cases, 2 of which required a third PK procedure.
  
  
  CONCLUSIONS
  Apparently quiet eyes with failed PK can harbor slow-growing asymptomatic infection. An epithelial defect in a failed PK graft should raise suspicion of infection. Routine cultures and histological examination of the excised corneal buttons are instrumental in the diagnosis of these infections and can guide further treatment.
authors.affiliation: *Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel; †Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; ‡Department of Ophthalmology, "Villa Igea" Hospital, Forlì, Italy; §Istituto internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy; and ¶Fondazione Banca degli Occhi del Veneto, Venice, Italy.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Nahum
authors.forename: Pia
authors.initials: P
authors.lastname: Leon
authors.forename: Benedetta Azzurra
authors.initials: BA
authors.lastname: Ricci-Filipovic
authors.forename: Davide
authors.initials: D
authors.lastname: Camposampiero
authors.forename: Diego
authors.initials: D
authors.lastname: Ponzin
authors.forename: Massimo
authors.initials: M
authors.lastname: Busin
mesh_terms: D000328:Adult; D000368:Aged; D058345:Asymptomatic Infections; D001419:Bacteria / Q000302:isolation & purification; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012017:Referral and Consultation; D012086:Reoperation; D012189:Retrospective Studies; D066167:Slit Lamp; D017211:Treatment Failure