Post-keratoplasty Infectious Keratitis: Epidemiology, Risk Factors, Management, and Outcomes
| Autor: | Darren Shu Jeng Ting, Harminder S Dua, Anna Song, Dalia G. Said, Rashmi Deshmukh, James Chodosh, Haotian Lin, Jodhbir S. Mehta, Marcus Ang |
|---|---|
| Přispěvatelé: | TING, DARREN, Apollo - University of Cambridge Repository |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Medicine (General) Corneal Infection interface infectious keratitis corneal graft Review keratoplasty Infectious Keratitis 03 medical and health sciences 0302 clinical medicine Endophthalmitis R5-920 corneal transplant Epidemiology Medicine Intensive care medicine business.industry Incidence (epidemiology) steroid Corneal Transplant Eye bank General Medicine corneal ulcer medicine.disease corneal infection eye bank 030221 ophthalmology & optometry business 030217 neurology & neurosurgery |
| Zdroj: | Frontiers in Medicine Frontiers in Medicine, Vol 8 (2021) |
| ISSN: | 2296-858X |
| Popis: | Post-keratoplasty infectious keratitis (PKIK) represents a unique clinical entity that often poses significant diagnostic and therapeutic challenges. It carries a high risk of serious complications such as graft rejection and failure, and less commonly endophthalmitis. Topical corticosteroids are often required to reduce the risk of graft rejection but their use in PKIK may act as a double-edged sword, particularly in fungal infection. The increased uptake in lamellar keratoplasty in the recent years has also led to complications such as graft-host interface infectious keratitis (IIK), which is particularly difficult to manage. The reported incidence of PKIK differs considerably across different countries, with a higher incidence observed in developing countries (9.2–11.9%) than developed countries (0.02–7.9%). Common risk factors for PKIK include the use of topical corticosteroids, suture-related problems, ocular surface diseases and previous corneal infection. PKIK after penetrating keratoplasty or (deep) anterior lamellar keratoplasty is most commonly caused by ocular surface commensals, particularly Gramme-positive bacteria, whereas PKIK after endothelial keratoplasty is usually caused by Candida spp. Empirical broad-spectrum antimicrobial treatment is the mainstay of treatment for both PKIK, though surgical interventions are required in medically refractory cases (during the acute phase) and those affected by visually significant scarring (during the late phase). In this paper, we aim to provide a comprehensive overview on PKIK, encompassing the epidemiology, risk factors, causes, management and outcomes, and to propose a treatment algorithm for systematically managing this challenging condition. |
| Databáze: | OpenAIRE |
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