Infectious Keratitis Following Corneal Transplantation: A Long-Term Cohort Study

To assess the long-term incidence and risk factors for post-keratoplasty infectious keratitis (IK), associated ocular pathogens, and antibiotic resistance profiles.

cumulative incidence of IK, infectious agent species, and antibiotics resistance profiles.

Cohort study including 2553 consecutive penetrating, endothelial, and anterior lamellar keratoplasties performed between 1992 and 2020. Medical and microbiological records of patients clinically diagnosed with IK were retrospectively reviewed.

The average follow-up time was 112 ± 96 months. Eighty-nine IK episodes were recorded. The cumulated incidence of postoperative IK was 10.25% at 20 years. The occurrence of  IK after transplantation was associated with lower graft survival. Rejection risk and postoperative epithelial complications were associated with a higher incidence of postoperative IK. Infectious agents included 41 bacteria, 10 HSV, 6 fungi, and 1 Acanthamoeba. The rate of antibiotic resistance was 0% for vancomycin, 13% for fluoroquinolones, 20% for rifamycin, 59% for aminoglycosides, and 73% for ticarcillin. In 41% of cases, patients were under prophylactic topical antibiotics before the infection. Topical antibiotics were associated with increased resistance.

IK (mainly bacterial) is a frequent complication of corneal transplantation in the long term. Vancomycin and fluoroquinolones can be considered as first-line treatments. Prolonged postoperative antibiotic preventive treatment is not advisable as it may increase antibiotic resistance.