Infectious keratitis after lamellar keratoplasty

被引:16
作者
Sharma, Namrata [1 ]
Kaur, Manpreet [1 ]
Titiyal, Jeewan S. [1 ]
Aldave, Anthony [2 ]
机构
[1] All India Inst Med Sci, Dr Rajendra Prasad Ctr Ophthalm Sci, New Delhi, India
[2] Univ Calif Los Angeles, David Geffen Sch Med, Jules Stein Eye Inst, Los Angeles, CA 90095 USA
关键词
post-lamellar keratoplasty in-fections; endothelial keratoplasty infections; anterior lamellar keratoplasty in-fections; anterior lamellar keratoplasty in-fectious keratitis; endothelial keratoplasty infectious  keratitis; AUTOMATED ENDOTHELIAL KERATOPLASTY; OPTICAL COHERENCE TOMOGRAPHY; CANDIDA INTERFACE KERATITIS; VIVO CONFOCAL MICROSCOPY; EYE BANK ASSOCIATION; FUNGAL KERATITIS; MICROBIAL KERATITIS; RISK-FACTORS; INTRASTROMAL VORICONAZOLE; BACTERIAL KERATITIS;
D O I
10.1016/j.survophthal.2020.11.001
中图分类号
R77 [眼科学];
学科分类号
100212 ;
摘要
Infectious keratitis after lamellar keratoplasty is a potentially devastating complication that may severely limit the visual and anatomical outcomes. The deep-seated location of the infiltrates, sequestration of the pathogenic microorganisms and limited penetration of the currently available antimicrobial agents often results in delayed diagnosis that may jeopardize the management in these cases. Fungal keratitis is more common as compared with bacterial or viral keratitis and classically presents as white interface infiltrates that may not be associated with significant inflammation. Confocal microscopy may help to establish a rapid diagnosis in such cases, and anterior segment optical coherence tomography may be used to determine the extent of infection and monitor its progression. Conservative measures such as topical antimicrobials and interface irrigation with antimicrobial agents may be done. Surgical intervention in the form of partial excision/removal of the graft in endothelial keratoplasty or a full-thickness keratoplasty is often required for the effective management of deep-seated infections. Timely diagnosis and intervention may result in complete resolution of infection in both anterior lamellar and endothelial keratoplasty. Infections after anterior lamellar keratoplasty have a fair prognosis, and a clear graft with functional visual acuity may be achieved in most cases. By contrast, infections after endothelial keratoplasty have a guarded prognosis, and the presence of concomitant endophthalmitis may further complicate the graft survival and visual outcomes. (c) 2020 Elsevier Inc. All rights reserved.
引用
收藏
页码:623 / 643
页数:21
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