Excisional penetrating keratoplasty for fungal interface keratitis after endothelial keratoplasty: surgical timing and visual outcome.

Autor: Fontana L; Ophthalmology Unit, Azienda USL - IRCCS di Reggio Emilia, Viale Risorgimento 80, 42010, Reggio Emilia, Italy. luifonta@gmail.com., Caristia A; Ophthalmology Unit, Azienda USL - IRCCS di Reggio Emilia, Viale Risorgimento 80, 42010, Reggio Emilia, Italy., Cornacchia A; Department of Ophthalmology, University of Cagliari, Cagliari, Italy., Russello G; Microbiology Department, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy., Moramarco A; Ophthalmology Unit, Azienda USL - IRCCS di Reggio Emilia, Viale Risorgimento 80, 42010, Reggio Emilia, Italy.
Jazyk: angličtina
Zdroj: International ophthalmology [Int Ophthalmol] 2021 Jan; Vol. 41 (1), pp. 363-373. Date of Electronic Publication: 2020 Sep 17.
DOI: 10.1007/s10792-020-01576-1
Abstrakt: Purpose: In this paper, we describe two cases of fungal interface infectious keratitis (IIK) developed after endothelial keratoplasty (EK) who underwent delayed therapeutic penetrating keratoplasty (TPK) with a poor visual outcome. Furthermore, we conducted a review of the literature and analyzed the visual outcomes of TPK in relation to the time from IIK diagnosis.
Methods: We searched the literature for fungal IIK cases occurred after EK and treated by TPK. We identified 17 cases of fungal IIK, mostly caused by Candida spp. (88%).
Results: Infection was diagnosed at a median time of 21 (range 1-90 days) days after EK. The median lag time between infection diagnosis and TPK was 30 (range 7-393) days. The median distance corrected visual acuity (DCVA) measured 4-12 months after surgery was 20/40 (range 20/200-20/20). When TPK was performed within one month from diagnosis, the final median DCVA was 20/30 (range 20/100-20/20), with 83% of patients achieving ≥ 20/40 vision. When TPK was carried out later, the final median DCVA was 20/50 (range 20/200-20/22) with 44% of patients achieving ≥ 20/40 vision. One patient in the early surgery and four patients in the late surgery group showed postoperative DCVA ≤ 20/100 despite clear grafts.
Conclusion: TPK with removal of the sequestered infection is advocated as a safe and effective measure to treat a post-EK infection. Early surgery allows a reduced exposure time to infection and therefore may result in better visual outcomes and lower risk of complications caused by prolonged inflammation.
Databáze: MEDLINE
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