Transcript BACTERIAL AND FUNGAL ENDOPHTHALMITIS AFTER …

BACTERIAL AND FUNGAL ENDOPHTHALMITIS
AFTER PENETRATING KERATOPLASTY
Sonika Gupta
Consultant Ophthalmology
Max Eye Care
New Delhi, India
Author has no financial interest
Purpose of the study
• Endophthalmitis following penetrating keratoplasty (PK) is a
rare but a sight threatening complication, with an incidence
ranging from 0.08% to 0.77%.
• It is difficult to estimate trends because of low incidence and
sparse reports.
• The present study was conducted to evaluate the incidence,
microbial spectrum, treatment modalities, visual outcome, and
graft status in endophthalmitis following PK in our set-up.
Methods
• Retrospective analysis of 258 consecutive penetrating
keratoplasties was carried out.
• The incidence of endophthalmitis was determined.
• The risk factors, microbiologic spectrum of vitreous sample
isolate, treatment given, graft status, and visual outcome were
studied.
Fig 1 shows endophthalmitis
developing 7 days after PK
Results
• The incidence of post-PK endophthalmitis was 1.5%
(4 /258 eyes) over a mean follow-up period of 7.75
± 2.2 months.
• The mean time interval between PK and
development of endophthalmitis was 9.25 ± 2.475
days.
• Three of vitreous aspirates were culture positive, and
one had organism identified on pathology specimen
(aspergillus sp.)
Results
• All the four eyes were aphakic.
• Treatment given was intravitreal antibiotics
vancomycin 1 mg /0.1 ml and ceftazidime 2.25
mg/0.1 ml (2 eyes) and pars plana vitrectomy (PPV)
in 2 eyes.
• Graft failure was observed in 2 eyes, one eye became
phthisical.
• Best-corrected visual acuity (BCVA) of 20/80 was
observed in one eye.
Table 1 showing clinical profile and outcome of
4 cases of post-PK endophthalmitis
Age/Sex
Indication
for PK
Time
between
PK &
endophthal
mitis
Risk
factors
Causative
organism
Treatment
Outcome at
last followup
Case 1
47/F
Infective
keratitis
12 days
Contaminat
ed donor
tissue
Aspergillus
sp.
PPV with
intravitreal
amphoteric
in-B 5
µgm/0.1 ml
Failed graft
Case 2
50/M
Perforated
corneal
ulcer
7 days
Wound
dehiscence
Streptococc
us sp.
Intravitreal
antibiotics
Failed graft
Case 3
68/M
Adherent
leucoma
15 days
Loose suture
removal with
replacement
of suture
Streptococc
us sp.
PPV
Phthisis
bulbi
Case 4
33/M
Adherent
leucoma
3 days
Contaminat
ed donor
tissue
Staphyloco
ccus sp.
Intravitreal
antibiotics
Clear graft
BCVA
20/80
Conclusion
• Our study reports high incidence of post-PK
endophthalmitis (1.5%) compared to previous reports
(0.08 -0.77%).In a developing country like ours,
constraints like availability of quality donor tissue
and inadequate compliance with treatment and
follow-up after surgery could be possible reasons for
the high incidence.
Conclusion
• The donor tissue should be routinely screened and
evaluated for microbial contamination to minimize
the risk.
• Strict asepsis during suture removal and early repair
of wound dehiscence is recommended.
• Endophthalmitis developing after PK is associated
with very poor prognosis. Early diagnosis and
aggressive intervention is mandatory to salvage the
eye.