GRAFTS UNDER SIEGE: RETROSPECTIVE ANALYSIS OF CORNEAL GRAFT INFECTIONS AT A TERTIARY EYE CENTRE

To analyse the risk factors, clinical presentations, outcomes and microbiological profile of corneal graft infections from a tertiary eye centre.

Tertiary eye centre in India 

Ambispective observational study at a tertiary eye centre in India from January 2023 to June 2025. The demographic details of cases with graft infections and their clinical characteristics were studied. The donor details and microbiological profile were also analyzed.

Fifty-eight cases of optical keratoplasty were analyzed, including 44 penetrating, 7 anterior lamellar, and 7 endothelial keratoplasties. The mean age at presentation was 48.8 ± 19.5 years, with a male predominance (75.8%). Most patients had no systemic illness (65.5%), and grafts were predominantly >8 mm in size. The median latent period between surgery and infection onset was 135 days. At presentation, the median epithelial defect size was 4 × 4.5 mm², with a median infiltrate size of 2.5 × 2.95 mm². Hypopyon was observed in 24.1% of cases. Initial management commonly included topical fortified cefazolin and tobramycin, while systemic antibiotics were administered in 74.1% of cases. A poor response to initial treatment was noted in 34.4%, and 53.4% required additional surgical interventions, most frequently graft replacement (32.8%). Graft infection was associated with loose sutures in 48.3% and concurrent topical steroid use in 74.1% of cases. Gram-positive cocci were the most frequently isolated pathogens. Donor tissue analysis revealed a mean death-to-preservation time of 12.5 ± 6.4 hours, with road traffic accidents being the leading cause of donor death. Notably, smaller grafts were significantly more associated with bacterial graft infections (p < 0.05).

Corneal graft infections were commonly linked to loose sutures, topical steroid use, and smaller graft sizes. Gram-positive cocci predominated, and over half of the cases required surgical intervention, underscoring the need for close postoperative surveillance.