Therapeutic Keratoplasty for Advanced Suppurative Keratitis

Abstract

Purpose: To determine indications, therapeutic success, and corneal transplantation techniques for advanced medically uncontrolled infectious keratitis. Design: Retrospective, interventional case series. Methods: A review of 92 consecutive patients (1991 to 2002) who underwent therapeutic keratoplasty for acute infectious keratitis performed at Singapore National Eye Centre. Causative organism(s) were identified and outcomes were evaluated in terms of infectious cure (therapeutic success), graft clarity, and visual acuity. Results: Pseudomonas aeruginosa (58.7%) and Fusarium species (32.3%) were the predominant organisms for bacterial and fungal keratitis, respectively. Keratoplasty types included penetrating keratoplasty (PK; n = 80) and lamellar keratoplasty (n = 12). Mean graft diameter was 9.5 mm (range, 5.5 to 14 mm). Seventy-four patients (80.4%) achieved therapeutic success after one keratoplasty procedure, three patients were cured after a second keratoplasty. Life-table survival analysis computed the one-year therapeutic survival for bacterial and fungal keratitis as 76.6% and 72.4%, respectively (P = .76). The Kaplan-Meier one-year survival rate for PK optical clarity was 72%. Twenty-two patients underwent repeat keratoplasty for various reasons (optical, n = 8; recurrent primary infection, n = 7; perforation or subsequent new infections, n = 7). Of the 15 patients for whom therapy failed, 11 had fungal keratitis. Infection recurrence time was four days to one year. Most recurrences (n = 11) appeared within six weeks after surgery. Conclusions: Therapeutic keratoplasty may treat severe, refractory infectious keratitis effectively. High cure rates are achievable, although infection recurrence despite prolonged treatment remains a significant problem in fungal keratitis. © 2007 Elsevier Inc. All rights reserved.