Outcomes of Post-Keratoplasty Microbial Keratitis: A 16-Year Analysis
Abstract
1. Introduction
2. Methods
- Full-thickness corneal transplant: Penetrating keratoplasty (PK);
- Posterior lamellar keratoplasty: Descemet stripping automated endothelial keratoplasty (DSAEK);
- Anterior lamellar keratoplasty: Deep anterior lamellar keratoplasty (DALK).
2.1. Data Collection
- (a)
- Topical therapy: antibacterial treatment included either monotherapy (using a fluoroquinolone, aminoglycoside, or chloramphenicol) or combination therapy (gentamicin plus vancomycin, or a fluoroquinolone combined with an aminoglycoside). Additional topical therapies comprised antifungal, antiviral, anti-amoebic agents, and corticosteroids.
- (b)
- Systemic therapy: immunosuppression.
2.2. Statistical Methods
3. Results
3.1. Demographics
3.2. Risk Factors and Clinical Characteristic
3.3. Visual Acuity
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Whole Cohort | Penetrating Keratoplasty (PKP) | Anterior Lamellar Keratoplasty (DALK) | Posterior Lamellar Keratoplasty (DSAEK) | p * |
---|---|---|---|---|---|
Number of transplants performed in our centre in 2008–2023, n (%) | 2869 & | 1897 (66.3) | 114 (4) | 821 (28.6) | - |
Number of microbial keratitis cases, n (%) | 125 (100.0) | 112 (89.6) | 10 (8) | 3 (2.4) | - |
Age at microbial keratitis, mean ± SD | 62.73 ± 17.45 | 63.21 ± 17.17 | 53.30 ± 19.73 | 76.00 ± 5.29 | 0.086 1 |
Sex, female, n (%) | 64 (51.2) | 58 (51.8) | 4 (40.0) | 2 (66.7) | 0.701 3 |
Eye, right, n (%) | 62 (50.4) | 58 (52.7) | 3 (30.0) | 1 (33.3) | 0.296 3 |
Systemic autoimmunological disease, n (%) | 41 (32.8) | 39 (34.8) | 1 (10.0) | 1 (33.3) | 0.163 |
Treatment mode, n (%) | |||||
Intpatient | 114 (93.4) | 102 (93.6) | 9 (90.0) | 3 (100.0) | 0.516 |
Outpatient | 8 (6.6) | 7 (6.4) | 1 (10.0) | 0 (0.0) | |
Hospitalization, days, median (IQR) | 9.00 (7.00; 12.00) | 9.00 (7.00; 12.00) | 3.00 (2.00; 12.00) | 13.00 (10.50; 17.00) | 0.200 2 |
Variable | Whole Cohort | Penetrating Keratoplasty (PK) | Anterior Lamellar Keratoplasty (DALK) | Posterior Lamellar Keratoplasty (DSAEK) | p |
---|---|---|---|---|---|
Number of microbial keratitis cases, n (%) | 125 (100.0) | 112 (100.0) | 10 (100.0) | 3 (100.0) | - |
Recurrent infections, n (%) | 72 (57.6) | 67 (59.8) | 4 (40.0) | 1 (33.3) | 0.317 |
Time from the last transplant to microbial keratitis, months, median (IQR) | 17.00 (6.00; 40.00) | 17.00 (5.75; 39.25) | 18.50 (11.25; 57.50) | 7.00 (6.00; 45.00) | 0.611 |
Time from the first transplant to microbial keratitis, months, median (IQR) | 76.00 (34.25; 143.75) | 81.00 (35.00; 144.00) | 12.00 # (12.00; 12.00) | - | 0.169 |
Indication for transplantation, n (%) | |||||
Active infection | 65 (52.0) | 59 (52.7) | 6 (60.0) | 0 (0.0) | 0.196 |
Post-infection corneal scar | 13 (10.4) | 11 (9.8) | 2 (20.0) | 0 (0.0) | |
Keratoconus | 12 (9.6) | 12 (10.7) | 0 (0.0) | 0 (0.0) | |
Bullous keratopathy | 22 (17.6) | 19 (17.0) | 0 (0.0) | 3 (100.0) | |
Immunological | 3 (2.4) | 2 (1.8) | 1 (10.0) | 0 (0.0) | |
Chemical burn | 5 (4.0) | 5 (4.5) | 0 (0.0) | 0 (0.0) | |
Corneal dystrophy | 1 (0.8) | 1 (0.9) | 0 (0.0) | 0 (0.0) | |
Other | 4 (3.2) | 3 (2.7) | 1 (10.0) | 0 (0.0) |
Variable | Whole Cohort | Penetrating Keratoplasty (PKP) | Anterior Lamellar Keratoplasty (DALK) | Posterior Lamellar Keratoplasty (DSAEK) | p |
---|---|---|---|---|---|
Contact lens use, n (%) | 2 (1.8) | 2 (2.0) | 0 (0.0) | 0 (0.0) | >0.999 |
Trauma, n (%) | 3 (2.7) | 3 (3.0) | 0 (0.0) | 0 (0.0) | >0.999 |
Glaucoma topical treatment, n (%) | 62 (52.5) | 55 (51.4) | 4 (50.0) | 3 (100.0) | >0.999 |
Glaucoma surgical history, n (%) | 28 (23.9) | 23 (21.7) | 3 (37.5) | 2 (66.7) | 0.380 |
Broken/loose suture, n (%) | 5 (4.0) | 4 (3.6) | 1 (10.0) | 0 (0.0) | 0.353 |
Dry eye syndrome, n (%) | 41 (32.8) | 37 (33.0) | 3 (30.0) | 1 (33.3) | >0.999 |
Recurrent erosions, n (%) | 46 (36.8) | 42 (37.5) | 2 (20.0) | 2 (66.7) | 0.327 |
Local immunosuppression at the time of infection, n (%) | 66 (56.4) | 62 (58.5) | 2 (25.0) | 2 (66.7) | 0.135 |
Systemic immunosuppression, n (%) | 59 (50.4) | 58 (54.7) | 1 (12.5) | 0 (0.0) | 0.028 |
Systemic immunosuppression—type, n (%) | |||||
MFM & | 18 (30.5) | 18 (31.0) | 0 (0.0) | 0 (0.0) | 0.305 |
Steroids | 14 (23.7) | 13 (22.4) | 1 (100.0) | 0 (0.0) | |
MFM + steroids | 23 (39.0) | 23 (39.7) | 0 (0.0) | 0 (0.0) | |
Others | 4 (6.8) | 4 (6.9) | 0 (0.0) | 0 (0.0) | |
Previous immunosuppression, n (%) | 59 (74.7) | 52 (74.3) | 4 (66.7) | 3 (100.0) | 0.651 |
Previous immunosuppression—type, n (%) | |||||
Steroids | 20 (45.5) | 15 (39.5) | 2 (66.7) | 3 (100.0) | 0.756 |
MFM | 6 (13.6) | 6 (15.8) | 0 (0.0) | 0 (0.0) | |
MFM + steroids | 18 (40.9) | 17 (44.7) | 1 (33.3) | 0 (0.0) | |
Time from ceased immunosuppression, months, median (IQR) | 22.50 (8.50; 43.50) | 22.50 (10.75; 36.00) | 46.00 (23.50; 109.00) | 4.00 (2.50; 37.00) | 0.616 |
Active uveitis, n (%) | 29 (23.2) | 28 (25.0) | 0 (0.0) | 1 (33.3) | 0.114 |
Therapeutic transplant, n (%) | 19 (17.3) | 18 (18.4) | 0 (0.0) | 1 (50.0) | 0.208 |
Variable | Whole Cohort | Penetrating on IMT | No IMT | p |
---|---|---|---|---|
BCVA—diagnosis, median (IQR) | 2.30 (1.50; 2.30) | 1.90 (1.23; 2.30) | 2.30 (1.60; 2.70) | 0.006 1 |
BCVA—discharge, median (IQR) | 1.90 (1.30; 2.30) | 1.90 (1.30; 2.30) | 2.30 (1.50; 2.40) | 0.052 1 |
BCVA—year one follow up visit, median (IQR) | 1.90 (0.90; 2.30) | 1.90 (0.70; 2.30) | 1.90 (0.90; 2.40) | 0.639 1 |
BCVA—visit preceding the microbial keratitis onset, median (IQR) | 1.60 (0.88; 2.30) | 1.30 (0.80; 1.90) | 1.60 (1.00; 2.30) | 0.022 1 |
Lens status, n (%) | ||||
Phacic, transparent PCIOL ACIOL Cataract Aphacic | 26 (22.6) | 15 (26.3) | 11 (19.3) | 0.230 |
65 (56.5) | 33 (57.9) | 32 (56.1) | ||
0 (0.0) | 0 (0.0) | 0 (0.0) | ||
13 (11.3) | 7 (12.3) | 6 (10.5) | ||
11 (9.6) | 2 (3.5) | 8 (14.0) | ||
Decompensated graft prior to IK, n (%) | 64 (54.7) | 34 (57.6) | 30 (51.7) | 0.649 |
Recurrent erosions, n (%) | 46 (36.8) | 26 (44.1) | 20 (34.5) | 0.383 |
Dry eye syndrome, n (%) | 41 (32.8) | 20 (33.9) | 21 (36.2) | 0.946 |
Perforation, n (%) | 16 (12.8) | 6 (10.2) | 9 (15.5) | 0.556 |
Number of lesions, n (%) | ||||
Multifocal Monofocal | 15 (12.8) | 7 (12.7) | 8 (14.5) | >0.999 |
102 (87.2) | 48 (87.3) | 47 (85.5) | ||
Therapeutic transplant, n (%) | 19 (17.3) | 6 (11.5) | 11 (21.6) | 0.269 |
Topical treatment, n (%) | ||||
Monotherapy Politherapy | 22 (18.0) | 10 (16.9) | 11 (19.6) | 0.895 |
0 (0.0) | 0 (0.0) | 0 (0.0) | ||
Evisceration, n (%) | 10 (8.0) | 6 (10.2) | 4 (6.9) | 0.762 |
Part of the cornea affected, n (%) | ||||
Central Midperipheral Peripheral Whole cornea | 61 (54.0) | 29 (54.7) | 29 (54.7) | 0.736 2 |
24 (21.2) | 9 (17.0) | 13 (24.5) | ||
23 (20.4) | 12 (22.6) | 9 (17.0) | ||
5 (4.4) | 3 (5.7) | 2 (3.8) |
Variable | Whole Cohort | Penetrating Keratoplasty (PKP) | Anterior Lamellar Keratoplasty (DALK) | Posterior Lamellar Keratoplasty (DSAEK) | p |
---|---|---|---|---|---|
BCVA—diagnosis, median (IQR) | 2.30 (1.50; 2.30) | 2.30 (1.52; 2.30) | 1.30 (0.50; 2.30) | 2.30 (2.10; 2.30) | 0.094 |
BCVA—discharge, median (IQR) | 1.90 (1.30; 2.30) | 1.90 (1.30; 2.30) | 1.75 (0.50; 2.40) | 1.90 (1.90; 2.10) | 0.550 |
BCVA—year one follow-up visit, median (IQR) | 1.90 (0.90; 2.30) | 1.90 (0.90; 2.30) | 2.10 (1.43; 3.03) | 1.40 (1.15; 1.65) | 0.439 |
BCVA—visit preceding the microbial keratitis onset, median (IQR) | 1.60 (0.88; 2.30) | 1.60 (0.90; 2.30) | 1.30 (1.15; 2.00) | 1.30 (1.00; 1.30) | 0.714 |
Variable | One Corneal Transplant | Multiple Corneal Transplants (2–5 Grafts) | p |
---|---|---|---|
Therapeutic transplant, n (%) | 11 (15.3) | 7 (19.4) | 0.784 |
Amniotic membrane, n (%) | 17 (20.7) | 7 (17.5) | 0.858 |
Evisceration, n (%) | 8 (9.8) | 2 (5.0) | 0.495 1 |
Topical treatment, n (%) | |||
Monotherapy Politherapy | 17 (21.0) | 5 (12.8) | 0.406 |
64 (79.0) | 34 (87.2) | ||
General treatment | 47 (57.3) | 22 (55.0) | 0.962 |
Variable | Univariate Model | Multivariate Model | ||||||
---|---|---|---|---|---|---|---|---|
ß | 95% CI for ß | Std. ß | p | ß | 95% CI for ß | Std. ß | p | |
Age, years | 0.00 | −0.01 to 0.01 | 0.06 | 0.523 | - | - | - | - |
Sex, female (vs. male) | −0.31 | −0.61 to −0.01 | −0.39 | 0.041 | - | - | - | - |
Transplant type | ||||||||
DALK (vs. PKP) | 0.53 | −0.06 to 1.11 | 0.65 | 0.077 | 0.65 | 0.09 to 1.21 | 0.83 | 0.024 |
DSAEK (vs. PKP) | 0.16 | −0.97 to 1.30 | 0.20 | 0.775 | −0.30 | −1.71 to 1.11 | −0.38 | 0.677 |
Number of transplants | −0.05 | −0.24 to 0.15 | −0.05 | 0.633 | - | - | - | - |
Hospitalization, days | −0.02 | −0.05 to 0.00 | −0.16 | 0.109 | - | - | - | - |
Recurrent infections | 0.32 | 0.01 to 0.63 | 0.40 | 0.040 | - | - | - | - |
Time from the last transplant to microbial keratitis, months | 0.00 | 0.00 to 0.00 | −0.11 | 0.265 | - | - | - | - |
Time from the first transplant to microbial keratitis, months | 0.00 | 0.00 to 0.00 | −0.32 | 0.072 | - | - | - | - |
Indication | ||||||||
Post-infection corneal scar (vs. active infection) | 0.01 | −0.49 to 0.52 | 0.02 | 0.960 | - | - | - | - |
Keratoconus (vs. active infection) | −0.53 | −1.05 to −0.01 | −0.65 | 0.047 | - | - | - | - |
Bullous keratopathy (vs. active infection) | −0.31 | −0.73 to 0.11 | −0.39 | 0.141 | - | - | - | - |
Immunological (vs. active infection) | −0.76 | −1.70 to 0.18 | −0.94 | 0.110 | - | - | - | - |
Chemical burn (vs. active infection) | −0.39 | −1.13 to 0.35 | −0.48 | 0.299 | - | - | - | - |
Other (vs. active infection) | −0.35 | −1.17 to 0.47 | −0.44 | 0.394 | - | - | - | - |
CL use | −0.05 | −1.21 to 1.11 | −0.07 | 0.927 | - | - | - | - |
Trauma | −0.21 | −1.16 to 0.74 | −0.26 | 0.664 | - | - | - | - |
Dry eye syndrome | −0.13 | −0.45 to 0.19 | −0.16 | 0.426 | - | - | - | - |
Recurrent erosions | 0.04 | −0.27 to 0.35 | 0.05 | 0.785 | - | - | - | - |
Perforation | 0.63 | 0.20 to 1.06 | 0.78 | 0.005 | 0.77 | 0.36 to 1.17 | 0.98 | <0.001 |
Local immunosuppression at the time of infection | −0.24 | −0.54 to 0.06 | −0.29 | 0.123 | - | - | - | - |
Systematic immunosuppression | 0.25 | −0.04 to 0.55 | 0.32 | 0.094 | 0.45 | 0.16 to 0.74 | 0.57 | 0.003 |
Systematic immunosuppression—type | ||||||||
Steroids (vs. MFM) | −0.06 | −0.69 to 0.56 | −0.07 | 0.843 | - | - | - | - |
MFM + steroids (vs. MFM) | −0.04 | −0.58 to 0.50 | −0.05 | 0.873 | - | - | - | - |
Others (vs. MFM) | 0.09 | −0.98 to 1.17 | 0.11 | 0.860 | - | - | - | - |
Previous immunosuppression | 0.10 | −0.28 to 0.49 | 0.14 | 0.591 | - | - | - | - |
Time from ceased immunosuppression, months | 0.00 | −0.01 to 0.00 | −0.09 | 0.619 | - | - | - | - |
Active uveitis | 0.18 | −0.18 to 0.53 | 0.22 | 0.332 | - | - | - | - |
Therapeutic transplant | −0.38 | −0.79 to 0.03 | −0.49 | 0.067 | - | - | - | - |
BCVA—diagnosis | 0.13 | −0.11 to 0.36 | 0.11 | 0.282 | - | - | - | - |
Topical treatment, monotherapy (vs. polytherapy) | −0.13 | −0.52 to 0.26 | −0.16 | 0.522 | - | - | - | - |
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Przybek-Skrzypecka, J.; Ryk-Adamska, M.; Skrzypecki, J.; Izdebska, J.; Udziela, M.; Major, J.; Szaflik, J.P. Outcomes of Post-Keratoplasty Microbial Keratitis: A 16-Year Analysis. J. Clin. Med. 2025, 14, 3165. https://doi.org/10.3390/jcm14093165
Przybek-Skrzypecka J, Ryk-Adamska M, Skrzypecki J, Izdebska J, Udziela M, Major J, Szaflik JP. Outcomes of Post-Keratoplasty Microbial Keratitis: A 16-Year Analysis. Journal of Clinical Medicine. 2025; 14(9):3165. https://doi.org/10.3390/jcm14093165
Chicago/Turabian StylePrzybek-Skrzypecka, Joanna, Małgorzata Ryk-Adamska, Janusz Skrzypecki, Justyna Izdebska, Monika Udziela, Joanna Major, and Jacek P. Szaflik. 2025. "Outcomes of Post-Keratoplasty Microbial Keratitis: A 16-Year Analysis" Journal of Clinical Medicine 14, no. 9: 3165. https://doi.org/10.3390/jcm14093165
APA StylePrzybek-Skrzypecka, J., Ryk-Adamska, M., Skrzypecki, J., Izdebska, J., Udziela, M., Major, J., & Szaflik, J. P. (2025). Outcomes of Post-Keratoplasty Microbial Keratitis: A 16-Year Analysis. Journal of Clinical Medicine, 14(9), 3165. https://doi.org/10.3390/jcm14093165