Luigi Fontana1, Alice Caristia2, Alessandra Cornacchia3, Giuseppe Russello4, Antonio Moramarco2. 1. Ophthalmology Unit, Azienda USL - IRCCS di Reggio Emilia, Viale Risorgimento 80, 42010, Reggio Emilia, Italy. luifonta@gmail.com. 2. Ophthalmology Unit, Azienda USL - IRCCS di Reggio Emilia, Viale Risorgimento 80, 42010, Reggio Emilia, Italy. 3. Department of Ophthalmology, University of Cagliari, Cagliari, Italy. 4. Microbiology Department, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Abstract
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.
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-EKinfection. 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.
Authors: Christina Y Weng; D Wilkin Parke; Scott D Walter; Ryan F Isom; Jonathan S Chang; Harry W Flynn Journal: JAMA Ophthalmol Date: 2014-11 Impact factor: 7.389
Authors: Anthony J Aldave; Jennifer DeMatteo; David B Glasser; Elmer Y Tu; Bernardino Iliakis; Michael L Nordlund; Jachin Misko; David D Verdier; Fei Yu Journal: Cornea Date: 2013-02 Impact factor: 2.651
Authors: Luigi Fontana; Antonio Moramarco; Erika Mandarà; Giuseppe Russello; Alfonso Iovieno Journal: Br J Ophthalmol Date: 2018-10-24 Impact factor: 4.638