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

2. 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.

3. 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

4. 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 ± days.
Three of vitreous aspirates were culture positive, and one had organism identified on pathology specimen (aspergillus sp.)

5. 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.

6. 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

7. Conclusion
Our study reports high incidence of post-PK endophthalmitis (1.5%) compared to previous reports ( %).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.

8. 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.