Excisional penetrating keratoplasty for fungal interface keratitis after endothelial keratoplasty: surgical timing and v
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REVIEW
Excisional penetrating keratoplasty for fungal interface keratitis after endothelial keratoplasty: surgical timing and visual outcome Luigi Fontana . Alice Caristia . Alessandra Cornacchia . Giuseppe Russello . Antonio Moramarco
Received: 20 May 2020 / Accepted: 29 August 2020 Ó Springer Nature B.V. 2020
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 L. Fontana (&) A. Caristia A. Moramarco Ophthalmology Unit, Azienda USL – IRCCS di Reggio Emilia, Viale Risorgimento 80, 42010 Reggio Emilia, Italy e-mail: [email protected] A. Cornacchia Department of Ophthalmology, University of Cagliari, Cagliari, Italy G. Russello Microbiology Department, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy
was performed within one month from diagnosis, the final median DCVA was 20/30 (range 20/100–20/20), with 83% of patients achieving C 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 C 20/40 vision. One patient in the early surgery and four patients in the late surgery group showed postoperative DCVA B 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. Keywords Interface infectious keratitis Fungal keratitis Endothelial keratoplasty Therapeutic penetrating keratoplasty
Introduction Infection arising at the graft-host interface represents a rare peculiar complication that extends to all forms of lamellar keratoplasty [1]. The implicated microorganisms are most commonly fungi, particularly Candida spp., and less frequently bacteria [2]. Recently, the Eye Bank Association of America reported a rate of fungal infection after endothelial keratoplasty (EK) of
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0.022% [3], but frequencies from single-center case series have been reported at 0.15% [4] and 0.92% [5]. Infectious interface keratitis (IIK) is especially challenging to diagnose and treat because the deep location of infection limits acces
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