Microbial keratitis following corneal transplantation

PURPOSE: To study clinical and microbiologic characteristics of corneal infections following penetrating keratoplasty (PK). DESIGN: Retrospective case series. METHODS: Medical records of patients who presented to Duke University Eye Center from January 1, 1999 to July 1, 2005 with microbial keratitis after PK were reviewed. RESULTS: Forty-four corneal graft infections were reviewed. Mean interval between PK and infection was 26.3 months. Associated conditions included broken or loose sutures (10, 22.7%) and topical corticosteroids (34, 77.3%). Staphylococcal (12, 20.7%) and Pseudomonal (7, 12.1%) species were common pathogens, and fungal species accounted for eight (18.2%) infections. Twelve patients (27.3%) had polymicrobial infections. Thirteen patients (29.5%) underwent repeat PK. Mean postinfection visual acuity at last follow-up was 20/400. CONCLUSIONS: Microbial infections within corneal grafts can occur anytime in the postoperative course and are associated with broken sutures and the use of topical corticosteroids. The diversity of pathogenic organisms, antibiotic resistance, and the potential for poor outcomes supports aggressive management of these infections.