Microbial Keratitis Associated With Penetrating Keratoplasty and Scleral Lens Wear: A Case Series

Objectives: To report on microbial keratitis (MK) in three scleral lens (SL) wearers who had undergone penetrating keratoplasty (PKP). Methods: This retrospective case series describes 3 cases of MK in patients who wore SLs after PKP. Results: All three patients wore SLs for visual rehabilitation for corneal irregularity induced by PKP; all three also had concurrent ocular surface disease (keratoconjunctivitis sicca and corneal exposure). Cultures identified the causative organism in two patients, and septated hyphae suggestive of fungal infection were identified in tissue removed during therapeutic PKP in the third patient. All three patients were receiving either topical or systemic immunosuppressive therapy before the infection developed. Conclusions: Scleral lenses are often used to manage complex ocular disease, which can make it difficult to determine the precise cause of complications that arise after wearing the lenses. Multiple factors, including SL wear, may have contributed to the initial development of MK in the three patients in this case series. Patients who wear SLs after PKP should be monitored closely.