Transcript 727: Therapeutic Penetrating Keratoplasty in Fungal Keratitis

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
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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
9%
5%
Aspergillus
Fusarium
Candida
Curvularia
36%
50%
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
12
PED
10
Reinfection
8
no. of
6
cases
4
Glaucoma
Rejection
2
0
complications
primary graft
failure
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.