BACTERIAL AND FUNGAL ENDOPHTHALMITIS AFTER PENETRATING KERATOPLASTY

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BACTERIAL AND FUNGAL ENDOPHTHALMITIS AFTER
PENETRATING KERATOPLASTY

• Sonika Gupta
• Consultant Ophthalmology
• Max Eye Care
• New Delhi, India
• Author has no financial interest

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Purpose of the study

• Endophthalmitis following penetrating
  keratoplasty (PK) is a rare but a sight
  threatening complication, with an incidence
  ranging from 0.08 to 0.77.
• It is difficult to estimate trends because of low
  incidence and sparse reports.
• The present study was conducted to evaluate the
  incidence, microbial spectrum, treatment
  modalities, visual outcome, and graft status in
  endophthalmitis following PK in our set-up.

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Methods

• Retrospective analysis of 258 consecutive
  penetrating keratoplasties was carried out.
• The incidence of endophthalmitis was determined.
• The risk factors, microbiologic spectrum of
  vitreous sample isolate, treatment given, graft
  status, and visual outcome were studied.

Fig 1 shows endophthalmitis developing 7 days
after PK
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Results

• The incidence of post-PK endophthalmitis was 1.5
  (4 /258 eyes) over a mean follow-up period of
  7.75 2.2 months.
• The mean time interval between PK and development
  of endophthalmitis was 9.25 2.475 days.
• Three of vitreous aspirates were culture
  positive, and one had organism identified on
  pathology specimen (aspergillus sp.)

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Results

• All the four eyes were aphakic.
• Treatment given was intravitreal antibiotics
  vancomycin 1 mg /0.1 ml and ceftazidime 2.25
  mg/0.1 ml (2 eyes) and pars plana vitrectomy
  (PPV) in 2 eyes.
• Graft failure was observed in 2 eyes, one eye
  became phthisical.
• Best-corrected visual acuity (BCVA) of 20/80 was
  observed in one eye.

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Table 1 showing clinical profile and outcome of 4
cases of post-PK endophthalmitis
Age/Sex Indication for PK Time between PK endophthalmitis Risk factors Causative organism Treatment Outcome at last follow-up
Case 1 47/F Infective keratitis 12 days Contaminated donor tissue Aspergillus sp. PPV with intravitreal amphotericin-B 5 µgm/0.1 ml Failed graft
Case 2 50/M Perforated corneal ulcer 7 days Wound dehiscence Streptococcus sp. Intravitreal antibiotics Failed graft
Case 3 68/M Adherent leucoma 15 days Loose suture removal with replacement of suture Streptococcus sp. PPV Phthisis bulbi
Case 4 33/M Adherent leucoma 3 days Contaminated donor tissue Staphylococcus sp. Intravitreal antibiotics Clear graft BCVA 20/80
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Conclusion

• Our study reports high incidence of post-PK
  endophthalmitis (1.5) compared to previous
  reports (0.08 -0.77).In a developing country
  like ours, constraints like availability of
  quality donor tissue and inadequate compliance
  with treatment and follow-up after surgery could
  be possible reasons for the high incidence.

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Conclusion

• The donor tissue should be routinely screened and
  evaluated for microbial contamination to minimize
  the risk.
• Strict asepsis during suture removal and early
  repair of wound dehiscence is recommended.
• Endophthalmitis developing after PK is associated
  with very poor prognosis. Early diagnosis and
  aggressive intervention is mandatory to salvage
  the eye.