Document Detail


Therapeutic keratoplasty for advanced suppurative keratitis.
MedLine Citation:
PMID:  17335767     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To determine indications, therapeutic success, and corneal transplantation techniques for advanced medically uncontrolled infectious keratitis. DESIGN: Retrospective, interventional case series. METHODS: A review of 92 consecutive patients (1991 to 2002) who underwent therapeutic keratoplasty for acute infectious keratitis performed at Singapore National Eye Centre. Causative organism(s) were identified and outcomes were evaluated in terms of infectious cure (therapeutic success), graft clarity, and visual acuity. RESULTS: Pseudomonas aeruginosa (58.7%) and Fusarium species (32.3%) were the predominant organisms for bacterial and fungal keratitis, respectively. Keratoplasty types included penetrating keratoplasty (PK; n = 80) and lamellar keratoplasty (n = 12). Mean graft diameter was 9.5 mm (range, 5.5 to 14 mm). Seventy-four patients (80.4%) achieved therapeutic success after one keratoplasty procedure, three patients were cured after a second keratoplasty. Life-table survival analysis computed the one-year therapeutic survival for bacterial and fungal keratitis as 76.6% and 72.4%, respectively (P = .76). The Kaplan-Meier one-year survival rate for PK optical clarity was 72%. Twenty-two patients underwent repeat keratoplasty for various reasons (optical, n = 8; recurrent primary infection, n = 7; perforation or subsequent new infections, n = 7). Of the 15 patients for whom therapy failed, 11 had fungal keratitis. Infection recurrence time was four days to one year. Most recurrences (n = 11) appeared within six weeks after surgery. CONCLUSIONS: Therapeutic keratoplasty may treat severe, refractory infectious keratitis effectively. High cure rates are achievable, although infection recurrence despite prolonged treatment remains a significant problem in fungal keratitis.
Authors:
Seng-Ei Ti; J Angus Scott; Prathiba Janardhanan; Donald T H Tan
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Publication Detail:
Type:  Journal Article     Date:  2007-02-28
Journal Detail:
Title:  American journal of ophthalmology     Volume:  143     ISSN:  0002-9394     ISO Abbreviation:  Am. J. Ophthalmol.     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-04-24     Completed Date:  2007-06-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370500     Medline TA:  Am J Ophthalmol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  755-762     Citation Subset:  AIM; IM    
Affiliation:
Singapore National Eye Centre, Singapore, Republic of Singapore.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Corneal Transplantation*
Corneal Ulcer / microbiology,  surgery*
Eye Infections, Bacterial / microbiology,  surgery*
Eye Infections, Fungal / microbiology,  surgery*
Female
Graft Survival
Humans
Keratoplasty, Penetrating*
Life Tables
Male
Middle Aged
Postoperative Complications
Recurrence
Retrospective Studies
Suppuration / surgery
Treatment Outcome
Visual Acuity

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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