Therapeutic Keratoplasty In Severe Suppurative Keratitis

To report the clinical results of emergency penetrating keratoplasty (PKP) in complicated cases of suppurative keratitis. 

Department of Ophthalmology, Habib Thameur University Hospital, Tunis, Tunisia. 

Retrospective monocentric observational study including eyes of patients who had a “hot” PKP for suppurative keratitis from February 2022 to January 2023. Main outcome measures were best-corrected visual acuity (BCVA) and secondary complications. BCVA was measured according to a decimal scale; hand motion was counted as 0.0052, finger counting at 1 meter as 0.014 and light perception as 0.0016. For diagnostic purposes, all patients underwent corneal scraping for microbiological culture analysis. Graft failure was defined as primary or secondary endothelial decompensation.

Eight eyes of 8 patients were included. Mean age was 46 years. Four patients had prior ocular surgery. Microbiological testing found fungal and Mycobacterium abscessus infections in one eye each, 6 were negative due to antibiotic use. PKP was indicated for corneal perforation in 6 eyes, and impending risk of perforation in 2 eyes. Mean time between indication and PKP surgery was 27 days. Three patients had PKP and simultaneous cataract surgery, one had PKP with intraocular lens explantation, and 4 had PKP only. Two months after PKP, BCVA improved from 0.1 to 0.2. Over a mean follow-up of 4.7 months, complications included transient ocular inflammation and corneal suture infection in one eye each and chronic endothelial rejection in 3 eyes.

Emergency PKP in complicated suppurative keratitis has acceptable postoperative results. It has poorer outcomes than routinely performed corneal transplants with an increased risk of early graft rejection. However, in cases of threatened or actual perforation of the cornea, it remains a valid treatment option to preserve the severely diseased eyes. Larger studies are needed to identify the impact of earlier PKP in cases of resistant suppurative keratitis.

Financial disclosure of all authors: None