Therapeutic Penetrating Keratoplasty in Fungal

Keratitis: Prospective Study

Sonika Gupta

Consultant Ophthalmology

Max Eye Care

New Delhi, India

Author has no financial interest

Purpose /Methods

• To study the outcome of therapeutic penetrating keratoplasty (TPK) in fungal keratitis, which is a major cause of corneal blindness in our set-up.

• A prospective database on 44 therapeutic keratoplasties in 44 patients of fungal keratitis recorded the following data

• demographic details on age and gender of the patient• indication for surgery• size of donor and recipient bed • causative organism and • complications.

Methods

• Indications for surgery included fungal keratitis not responding to maximal medical therapy, desmetocele with infiltrates, or a perforation of more than 2 mm in the presence of active inflammation.

• All patients underwent TPK by a similar method that involved a donor button that was oversized by 0.5 mm and 16 bites of interrupted sutures with 10-0 monofilament nylon.

• Minimum follow-up period was 1 year.• Excised host cornea was sent for microbiologic and

histopathologic examination.

Methods

• Outcomes were evaluated in terms of anatomical success, graft clarity and visual acuity.

Effect of graft size, causative organism and perforation on the final outcome was analyzed.

• Statistical analysis: Chi-square tests were performed for categorical variables.

• A p-value of 0.05 was considered significant.

Results

• Mean age of patients was 45.98 ± 18.23 years (range 14-80 years).

• There were 30 males, 14 females.• Thirteen eyes had perforation at presentation.• Mean graft diameter was 9.0mm ( range 7.5 to 11

mm).• Isolates identified were Aspergillus (50%),

Fusarium (36%),Candida (9.0%) and Curvularia (4.5%).

Causative organisms

5%

50%

36%

9%

Aspergillus

Fusarium

Candida

Curvularia

Results

• Anatomical success seen in 42 eyes (95.4%). • Grafts in 18 eyes (40.9%) remained clear during

follow-up. • Visual acuity ≥ 20/200 achieved in 9 eyes (20.4%). • Graft size, species of organism and perforation did

not significantly affect anatomical success and visual outcome.

Results

• Graft size significantly correlated with graft clarity (p= 0.0016 chi- square test).

• No correlation was found between perforation and organism species with graft clarity (p=0.39).

• Complications : persistent epithelial defect in 12 eyes (27.2%) , reinfection 5 (11.3%), glaucoma 4 (9.%), rejection 3 (6.8%), primary graft failure 2 (4.5%) .

Complications after TPK in fungal keratitis

0

2

4

6

8

10

12

no. of cases

complications

PED

Reinfection

Glaucoma

Rejection

primary graftfailure

Persistent epithelial defect after TPK in fungal keratitis

Graft infection after TPK in fungal keratitis

Conclusion

• TPK is successful in maintaining the ocular integrity in most eyes with fungal keratitis.

Lower number of clear grafts in our study could be due to

• Delay in presentation by the patient leading to delayed surgical intervention

• Lack of availability of good quality donor tissue.• Inadequate compliance with follow-up.