Post penetrating keratoplasty infectious keratitis: Clinico-microbiological profile and predictors of outcome

2021 ◽  
pp. 112067212110629
Author(s):  
Abhishek Dave ◽  
Sanil Sawant ◽  
Manisha Acharya ◽  
Arpan Gandhi ◽  
Atanu Majumdar ◽  
...  
Keyword(s):  
Graft Failure ◽  
Penetrating Keratoplasty ◽  
Surgical Intervention ◽  
Graft Infection ◽  
Multivariate Logistic Regression Analysis ◽  
Fungal Growth ◽  
Infectious Keratitis ◽  
Microbiological Profile ◽  
High Incidence ◽  
Graft Success

Purpose To study the clinico-microbiological profile, outcomes and prognostic factors of post penetrating keratoplasty (PKP) infectious keratitis. Methods Retrospective review of medical records of 78 patients with post PKP infectious keratitis presenting between January 2014 and December 2018. Demographic, clinical and microbiological profile was documented and predictors of treatment and graft success were evaluated using univariate and subsequent multivariate logistic regression analysis. Results Mean age of patients was 52.17 ± 15.51 years and mean infiltrate size was 19.39 ± 19.68 mm2. Mean duration of presentation with infection post PKP was 11.66 ± 10.65 months. Culture positivity was seen in 64 eyes (82.05%). Bacterial growth was observed in 47 eyes (60.25%), fungal growth in 17 (21.79%) and no microbiological growth in 14 eyes (17.94%). At 3 months the visual acuity (VA) improved in 37 eyes (47.44%), did not change in 27 (34.62%) and deteriorated in 14 (17.95%). Graft failure was noted in 53 eyes (73.08%). Surgical intervention was needed in 47 (60.25%) eyes of which most common was therapeutic PKP in 32 eyes (41.02%). Treatment failure was noted with fungal infection ( p = 0.05), poorer vision at presentation ( p = 0.02), larger infiltrate area ( p = 0.002) and graft infection developing before 1 year ( p = 0.02). Graft failure was noted with associated endophthalmitis ( p = 0.02), poorer VA at presentation ( p = 0.01) and larger infiltrate area ( p = 0.02). Conclusion Post PKP infectious keratitis is a sight threatening ocular condition. It is associated with high incidence of graft failure and frequently requires surgical intervention. Fungal etiology, larger infiltrate size, poorer vision at presentation and associated endophthalmitis carries a poorer prognosis.

Survey of Rejection Prophylaxis Following Suture Removal in Penetrating Keratoplasty in Germany

2021 ◽  
Author(s):  
Sonja Heinzelmann ◽  
Daniel Böhringer ◽  
Philip Christian Maier ◽  
Berthold Seitz ◽  
Claus Cursiefen ◽  
...  
Keyword(s):  
Graft Rejection ◽  
Graft Failure ◽  
Penetrating Keratoplasty ◽  
Treatment Strategies ◽  
Cost Benefit ◽  
Topical Steroids ◽  
Evidence Based ◽  
Systematic Analysis ◽  
Open Questions ◽  
The Face

Abstract Background Penetrating keratoplasty (PK) gets more and more reserved to cases of increasing complexity. In such cases, ocular comorbidities may limit graft survival following PK. A major cause for graft failure is endothelial graft rejection. Suture removal is a known risk factor for graft rejection. Nevertheless, there is no evidence-based regimen for rejection prophylaxis following suture removal. Therefore, a survey of rejection prophylaxis was conducted at 7 German keratoplasty centres. Objective The aim of the study was documentation of the variability of medicinal aftercare following suture removal in Germany. Methods Seven German keratoplasty centres with the highest numbers for PK were selected. The centres were sent a survey consisting of half-open questions. The centres performed a mean of 140 PK in 2018. The return rate was 100%. The findings were tabulated. Results All centres perform a double-running cross-stitch suture for standard PK, as well as a treatment for rejection prophylaxis with topical steroids after suture removal. There are differences in intensity (1 – 5 times daily) and tapering (2 – 20 weeks) of the topical steroids following suture removal. Two centres additionally use systemic steroids for a few days. Discussion Rejection prophylaxis following PK is currently poorly standardised and not evidence-based. All included centres perform medical aftercare following suture removal. It is assumed that different treatment strategies show different cost-benefit ratios. In the face of the diversity, a systematic analysis is required to develop an optimised regimen for all patients.

scholarly journals Transplantation of CD34+ enriched allografts in children with nonmalignant diseases: does graft manipulation necessarily result in high incidence of graft failure?

2003 ◽  
Vol 33 (1) ◽  
pp. 125-126 ◽  
Author(s):  
P Lang ◽  
R Handgretinger ◽  
J Greil ◽  
P Bader ◽  
M Schumm ◽  
...  
Keyword(s):  
Graft Failure ◽  
High Incidence

Efficacy and Safety of Systemic Tacrolimus in High-Risk Penetrating Keratoplasty After Graft Failure With Systemic Cyclosporine

Cornea ◽  
2014 ◽  
Vol 33 (11) ◽  
pp. 1157-1163 ◽  
Author(s):  
Kyoko Yamazoe ◽  
Katsuya Yamazoe ◽  
Takefumi Yamaguchi ◽  
Masahiro Omoto ◽  
Jun Shimazaki
Keyword(s):  
High Risk ◽  
Graft Failure ◽  
Penetrating Keratoplasty ◽  
Efficacy And Safety

Surgical Ascariasis in Children in Kashmir

1997 ◽  
Vol 27 (1) ◽  
pp. 13-14 ◽  
Author(s):  
Satish Kumar Pandit ◽  
Habib Ullah Zarger
Keyword(s):  
Retrospective Study ◽  
Intestinal Obstruction ◽  
Endemic Area ◽  
Surgical Intervention ◽  
Ileal Perforation ◽  
Biliary Ascariasis ◽  
High Incidence ◽  
Surgical Conditions

A retrospective study of 85 children aged 3–12 years revealed 25 cases who needed surgical intervention due to ascariasis. The surgical conditions found at laparotomy were intestinal obstruction (18) appendicitis (3), ileal perforation (2), biliary ascariasis (2). The study highlights the high incidence of surgical ascariasis among children with abdominal complaints in an endemic area.

Infectious Keratitis in Western Nepal: An Experience from a Tertiary Care Hospital

2018 ◽  
Author(s):  
Rajani Shrestha ◽  
Niranjan Nayak ◽  
Babita Gurung ◽  
Shishir Gokhale
Keyword(s):  
Antibiotic Susceptibility ◽  
Fungal Growth ◽  
Severe Form ◽  
Fungal Keratitis ◽  
Clinical Severity ◽  
Diffusion Method ◽  
Eye Drops ◽  
Infectious Keratitis ◽  
History Of ◽  
Predisposing Conditions

Abstract Background: Corneal blindness is a major public health problem worldwide and infectious keratitis is one of its leading causes. The aim was is to analyze the microbial etiology of corneal ulcers and to determine the antibiotic susceptibility pattern of bacterial isolates in order to find out the existing drug resistance pattern. Methods: Corneal scrapings were collected as per the standard procedure. All the isolates were identifies by conventional microbiological techniques. Antibiotic susceptibility testing was performed using disc diffusion method. Clinical grading of the ulcerative lesion was carried out by the recommended protocol. Results: Among the 84 cases of clinically diagnosed infectious keratitis investigated, 33 (39.3%) were farmers by occupation. All cases were reviewed for predisposing conditions and clinical severity. Ulcers were categorized as mild in 49 cases moderate in 12 and severe in 23 cases. Predisposing conditions were found in 55(65.5%) of the 84 cases. Forty-two cases showed culture positivity. Among these 42; 25 (29.7%) yielded fungal growth, 13(30.1%) yielded bacteria and the rest 4 (4.7%) showed mixed growth. Aspergillus spp. (10/29; 34.5%) were the commonest fungi isolated followed by Fusarium spp. (6/29; 20%). Similarly, Staphylococcus aureus, (8/17; 47%) was the most common among bacteria. Majority i.e 66.7% (26 of 39) of those having trauma, as the predisposing factor developed moderate to severe degree of corneal ulceration as compared to only 20% (9 of 45) of those without any history of trauma. (p<0.001). Interestingly, 20(68.9%) of the 29 cases that had yielded fungal growth on culture had had previous history of ocular trauma in contrast to only 19 (34.5%) of the 55 who had non-fungal origin of keratitis. (p=0.003). Fungal keratitis cases presented with more severe form of ulcerative lesions exhibiting more often with infiltrates and hypopion as compared to bacterial keratitis. Topical administration of fourth generation fluoroquinolone eye drops remained the most effective drug of choice with clinical improvement in all cases without any complications. Conclusions: Trauma with vegetative matter predisposed to most cases of fungal keratitis. Severe form of ulceration was noticed in patients with fungal infection. Surveillance of the antibiotic sensitivity is needed for quality patient management.

Effectiveness of Histocompatibility Matching in High-Risk Corneal Transplantation

2020 ◽  
pp. 1-8
Author(s):  
Alan D. Penman ◽  
Kimberly W. Crowder ◽  
William M. Watkins
Keyword(s):  
High Risk ◽  
Graft Failure ◽  
Corneal Transplantation ◽  
Corneal Graft ◽  
Hla Dr ◽  
Risk Patients ◽  
Graft Success ◽  
Group Matching ◽  
Corneal Graft Failure

The Collaborative Cornea Transplant Studies (CCTS) comprised two randomized, double-masked, clinical trials, the Antigen Matching Study (AMS) and the Crossmatch Study (CS), designed to determine whether matching HLA-A, -B, and/or HLA-DR antigens, donor-recipient crossmatching, or ABO compatibility reduced the risk of corneal allograft rejection and failure in high-risk patients. The studies showed that for patients needing a corneal graft with uncompromised immune systems and at high risk for corneal graft rejection: (1) neither HLA-A, -B, nor HLA-DR antigen matching substantially reduces the likelihood of corneal graft failure; (2) a positive donor-recipient crossmatch does not dramatically increase the risk of corneal graft failure; and (3) ABO blood group matching may be effective in reducing the risk of graft failure. Intensive steroid therapy after transplantation, frequent follow-up, medication and follow-up compliance, and patient education appear to play a significant role in corneal graft success.

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