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Excisional penetrating keratoplasty for fungal interface keratitis after endothelial keratoplasty: surgical timing and visual outcome

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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.

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Funding

No funding was received for the conduction of this study and the publication of this article.

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Authors and Affiliations

  1. Ophthalmology Unit, Azienda USL – IRCCS di Reggio Emilia, Viale Risorgimento 80, 42010, Reggio Emilia, Italy

    Luigi Fontana, Alice Caristia & Antonio Moramarco

  2. Department of Ophthalmology, University of Cagliari, Cagliari, Italy

    Alessandra Cornacchia

  3. Microbiology Department, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy

    Giuseppe Russello

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  1. Luigi Fontana
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  3. Alessandra Cornacchia
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Correspondence to Luigi Fontana.

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Fontana, L., Caristia, A., Cornacchia, A. et al. Excisional penetrating keratoplasty for fungal interface keratitis after endothelial keratoplasty: surgical timing and visual outcome. Int Ophthalmol 41, 363–373 (2021). https://doi.org/10.1007/s10792-020-01576-1

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