Therapeutic Penetrating Keratoplasty in Fungal Keratitis: Prospective Study Sonika Gupta Consultant Ophthalmology Max Eye Care New Delhi, India Author.

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Therapeutic Penetrating Keratoplasty in Fungal Keratitis: Prospective Study Sonika Gupta Consultant Ophthalmology Max Eye Care New Delhi, India Author has no financial interest

Purpose /Methods To study the outcome of therapeutic penetrating keratoplasty (TPK) in fungal keratitis, which is a major cause of corneal blindness in our set-up. A prospective database on 44 therapeutic keratoplasties in 44 patients of fungal keratitis recorded the following data demographic details on age and gender of the patient indication for surgery size of donor and recipient bed causative organism and complications.

Methods Indications for surgery included fungal keratitis not responding to maximal medical therapy, desmetocele with infiltrates, or a perforation of more than 2 mm in the presence of active inflammation. All patients underwent TPK by a similar method that involved a donor button that was oversized by 0.5 mm and 16 bites of interrupted sutures with 10-0 monofilament nylon. Minimum follow-up period was 1 year. Excised host cornea was sent for microbiologic and histopathologic examination.

Methods Outcomes were evaluated in terms of anatomical success, graft clarity and visual acuity. Effect of graft size, causative organism and perforation on the final outcome was analyzed. Statistical analysis: Chi-square tests were performed for categorical variables. A p-value of 0.05 was considered significant.

Results Mean age of patients was ± years (range years). There were 30 males, 14 females. Thirteen eyes had perforation at presentation. Mean graft diameter was 9.0mm ( range 7.5 to 11 mm). Isolates identified were Aspergillus (50%), Fusarium (36%),Candida (9.0%) and Curvularia (4.5%).

Causative organisms

Results Anatomical success seen in 42 eyes (95.4%). Grafts in 18 eyes (40.9%) remained clear during follow-up. Visual acuity ≥ 20/200 achieved in 9 eyes (20.4%). Graft size, species of organism and perforation did not significantly affect anatomical success and visual outcome.

Results Graft size significantly correlated with graft clarity (p= chi- square test). No correlation was found between perforation and organism species with graft clarity (p=0.39). Complications : persistent epithelial defect in 12 eyes (27.2%), reinfection 5 (11.3%), glaucoma 4 (9.%), rejection 3 (6.8%), primary graft failure 2 (4.5%).

Complications after TPK in fungal keratitis

Persistent epithelial defect after TPK in fungal keratitis

Graft infection after TPK in fungal keratitis

Conclusion TPK is successful in maintaining the ocular integrity in most eyes with fungal keratitis. Lower number of clear grafts in our study could be due to Delay in presentation by the patient leading to delayed surgical intervention Lack of availability of good quality donor tissue. Inadequate compliance with follow-up.