BACTERIAL AND FUNGAL ENDOPHTHALMITIS AFTER PENETRATING KERATOPLASTY

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Presentation transcript:

BACTERIAL AND FUNGAL ENDOPHTHALMITIS AFTER PENETRATING KERATOPLASTY Sonika Gupta Consultant Ophthalmology Max Eye Care New Delhi, India Author has no financial interest

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.

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

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.)

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.

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 Case 3 68/M Adherent leucoma 15 days Loose suture removal with replacement of suture PPV Phthisis bulbi Case 4 33/M Adherent leucoma 3 days Staphylococcus sp. Clear graft BCVA 20/80

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.

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.