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Kim, Oh, Kim, Han, Lee, and Wee: Clinical Manifestation and Predisposing Factors of Infectious Keratitis Following Penetrating Keratoplasty in Korean Patients
Original Article

J Korean Ophthalmol Soc 2010;51(4):504-509.

Published online: 25 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.4.504

Clinical Manifestation and Predisposing Factors of Infectious Keratitis Following Penetrating Keratoplasty in Korean Patients

Mijin Kim, MD1, Joo Youn Oh, MD1, 2, Mee Kum Kim, MD1, 2, Sang Beom Han, MD1, 3, Jin Hak Lee, MD1, 3, Won Ryang Wee, MD1, 2,

1Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

2Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea

3Bundang Seoul National University Hospital, Seongnam, Korea

Address reprint requests to Won Ryang Wee, MD. Department of ophthalmology, Seoul National University College of Medicine #28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea Tel: 82-2-2072-2438, Fax: 82-2-741-3187, E-mail: wrwee@snu.ac.kr

Received 29 June 2009       Accepted 9 December 2009

Copyright © 2010 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report the clinical manifestation, predisposing factors, microbiological profiles and treatment outcome of infectious keratitis following penetrating keratoplasty (PK).

Methods

Medical records of the post-PK patients later diagnosed with culture-positive keratitis, between January 2003 and June 2008 at our hospital were retrospectively reviewed.

Results

Among 228 eyes of 226 patients who previously had PK, 18 eyes (7.89%) of 16 patients developed microbial keratitis. Fifteen patients had a bacterial infection, of which a Streprococcus species was the most common causative microorganism (6 eyes, 33.3%). Three eyes had fungal infection; one case was co-infected with bacteria. Six eyes (33.3%) presented with a suture-related problem, and sixteen eyes (88.9%) had been using topical glaucoma medications. The suture-related problem and use of glaucoma medication were significantly associated with the development of infectious keratitis (p=0.040 and 0.013, respectively). Remission was achieved in all cases within the mean duration of 2.47 months after treatment initiation. However, visual improvement was not achieved in 11 eyes (68.7%) due to graft opacity.

Conclusions

Early identification of predisposing factors and appropriate management at an early stage may prevent the occurrence of graft infection and improve graft survival.

Keywords: Cornea, Infections, Penetrating keratoplasty

References

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Table 1.
Patient summary
No Age Sex Indications for corneal graft Laterality Isolated organism Months to infection
1 74 M PBK OS Streptococcus pneumoniae 3
2 75 F PBK OS Pseudomonas putida 13
3* 63 F Herpes simplex keratitis OD Coagulase negative Staphylococcus 0.33
3* Pseudomonas fluorescens/putida 39
4 69 F PBK OS Acremonium species, Corynebacterium species 20
5 71 F Herpes simplex keratitis OD Methicillin Resistant Staphylococcus Epidermidis 10
6 34 M Exposure keratopathy OS Streptococcus pneumoniae 9
7* 48 M Traumatic corneal laceration OS Streptococcus mitis 11
7*     Bacterial keratitis OS Acinetobacter baumannii, Acinetobacter lwoffii 2
8 51 M Chemical burn OD Delftia(Comamonas) acidovorans 15
9 73 M Herpes simplex keratitis OS Serratia marcescens 7
10 72 M PBK OS Granulicatella adiacens 24
11 63 M ABK OS Candida albicans 26
12 69 F PBK OD Streptococcus, Corynebacterium 4
13 59 M Salzmann's nodular degeneration OS Streptococcus pneumoniae 21
14 8 M Corneal opacity, S/P Shield ulcer OS Streptococcus pneumoniae 4
15 64 F Corneal opacity with unknown cau use OD Fusarium species 37
16 39 M Corneal opacity with unknown cau use OS Staphylococcus aureus 16

* Multiple recurrent episodes of infection in the same eye. PBK=pseudophakic bullous keratopathy; ABK=aphakic bullous keratopathy.

Table 2.
Microbiological profiles
Bacteria 17 (85.0%)
Streptococcus species 6 (30.0%)
   S.pneumoniae 5 (20.0%)
   S.mitis 1 (5.0%)
Staphylococcus species 3 (15.0%)
Pseudomonas species 2 (10.0%)
Corynebacterium species 2 (10.0%)
Serratia marcescens 1 (5.0%)
Actinetobacter baumannii 1 (5.0%)
Delftia acidovorans lwoffii 1 (5.0%)
Granulicatella adiacens 1 (5.0%)
Fungus 3 (15.0%)
Candida albicans 1 (5.0%)
Fusarium species 1 (5.0%)
Acremonium species 1 (5.0%)
Table 3.
Dermographics and predisposing factors
  Infectious keratitis (+) Infectious keratitis (−) P-value
No 18 eyes 210 eyes  
Sex (M:F) 11 (61%):7 (38.9%) 131 (62.4%):79 (37.6%) 1.0
Age (yrs) 58.2±4.59 50.3±1.26 0.096
Laterality (OD:OS) 6 (33.3%):12 (66.7%) 101 (48.1%):109 (51.9%) 0.325
Diabetes mellitus 5 eyes (27.7%) 22 eyes (10.9%) 0.128
Previous history of graft rejection 5 eyes (27.7%) 67 eyes (31.9%) 0.798
Duration of topical steroid use 18.1 months 23.5 months 0.177
Suture-related problem* 6 eyes (33.3%) 31 eyes (14.8%) 0.04
Use of glaucoma eyedrops* 15 eyes (83.0%) 80 eyes (42.8%) 0.013

* p<0.05.

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