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Therapeutic Penetrating Keratoplasty in Fungal Keratitis: Prospective Study

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.

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Therapeutic Penetrating Keratoplasty in Fungal Keratitis: Prospective Study

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

  2. 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.

  3. 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.

  4. 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.

  5. Results • Mean age of patients was 45.98 ± 18.23 years (range 14-80 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%).

  6. Causative organisms

  7. 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.

  8. Results • Graft size significantly correlated with graft clarity (p= 0.0016 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%) .

  9. Complications after TPK in fungal keratitis

  10. Persistent epithelial defect after TPK in fungal keratitis

  11. Graft infection after TPK in fungal keratitis

  12. 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.

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