Outcome of therapeutic keratoplasty in fungal keratitis

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Outcome of therapeutic keratoplasty in fungal
keratitis

• Sonika Gupta, MS
• Assistant Professor,
• GMCH, Chandigarh, India
• Author has no financial interest

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Purpose of Study

• To study the outcome of therapeutic penetrating
  keratoplasty (TPK) in fungal keratitis, which is
  a major cause of corneal blindness in our set-up.

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Cases of fungal keratitis
Fungal plaque with hypopyon
Feathery margins
Corneal abscess
Infitrates with pigmentation
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Methods

• ? A prospective database on 44 therapeutic
  keratoplasties in 44 patients of fungal keratitis
  recorded the following data-demographic details
  on age and gender of the patient, indication for
  surgery, size of donor and recipient bed
  causative organism and complications.
• Indications for surgery -fungal keratitis not
  responding to maximal medical therapy,
  desmetocele with infiltrates, or a perforation of
  more than 2 mm in the presence of active
  inflammation.
• All patients underwent TPK by a similar method
  -a donor button oversized by 0.5 mm and 16 bites
  of interrupted sutures with 10-0 monofilament
  nylon.

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Methods

• Minimum follow-up period was 1 year.
• Excised host cornea was sent for microbiologic
  and histopathologic examination.
• Outcomes were evaluated in terms of anatomical
  success, graft clarity and visual acuity.
• ? Effect of graft size, causative organism and
  perforation on the final outcome was analyzed.
• Statistical analysis Chi-square tests were
  performed for categorical variables.
• A p-value of 0.05 was considered significant.

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Results

• Mean age of patients was 45.98 18.23 years
  (range 14-80 years). 30 males, 14 females.
• Thirteen eyes had perforation at presentation.
• Mean graft diameter was 9.0 mm (range 7.5 -11
  mm)
• Isolates identified were Aspergillus (50),
  Fusarium (36),Candida (9.0) and Curvularia
  (4.5).

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Results

• Anatomical success seen in 42 eyes (95.4).
• Grafts in 18 eyes (40.9) remained clear during
  follow-up.
• Visual acuity 20/200 achieved in 9 eyes
  (20.4).
• Graft size, species of organism and perforation
  did not significantly affect anatomical success
  and visual outcome.
• Graft size significantly correlated with graft
  clarity (p 0.0016 chi- square test).
• No correlation was found between perforation and
  organism species with graft clarity (p0.39).

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Clear graft after TPK
Fungal corneal abscess

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Complications after TPK in fungal
keratitis
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Complications after TPK in fungal
keratitis
Graft infection
Persistent epithelial defect
Graft failure
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Discussion

• Xie et al Br J Ophthalmol 2001
• Retrospective analysis of 108 cases
• Corneal grafts clear in 86 eyes (79.6).
• Complications graft rejection (29.6),
  reinfection (7.4), cataract (4.6).
• Vision better than 20/60 was seen in 26.8 of
  eyes.
• Ti et al American J Ophthalmol May 2007
  
• TPK in fungal keratitis n31
• Fusarium sp.(32.3) predominant causative
  organism.
• One year therapeutic survival 72.4.

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Conclusion

• TPK is successful in maintaining the ocular
  integrity in most eyes with fungal keratitis.
• Lower number of clear grafts in our study
  could be due to
• Delay in presentation by the patient leading to
  delayed surgical intervention
• Lack of availability of good quality donor
  tissue.
• Inadequate compliance with follow-up.