Corneal Ulcers After Penetrating And Deep Anterior Lamellar Keratoplasty: Etiology, Risk Factors And One-Year Outcomes

To report cases of corneal ulcers occurring after keratoplasty (PKP and DALK) and to highlight the diagnostic difficulties and management strategies required to preserve graft clarity and visual outcome.

Prof. Dr. Hazem Yassin ophthalmolgy centers

This retrospective case series included 15 eyes that developed corneal ulcers after keratoplasty, comprising 10 DALK and 5 PKP procedures. All patients were followed for 12 months. Data collected included time to ulcer onset, underlying etiology (infectious versus non-infectious), predisposing risk factors, microbiological findings when indicated, management strategy and final graft outcome

Ulcer etiology was infectious in 30% and non-infectious in 70%.
Among infectious cases, microbiological cultures were positive in 40% (6/15 overall)

Non-infectious causes included:
    •    Persistent epithelial defect
    •    Neurotrophic keratopathy
    •    Suture-related inflammation
    •    Sterile melt / immune-related ulceration

Predisposing risk factors included prolonged topical steroid use, loose sutures, ocular surface disease and previous herpetic keratitis.

Medical management alone was sufficient in 60% of cases, while surgical intervention was required in 40%.

At one-year follow-up:
    •    Graft clarity was maintained in 50% of DALK versus 50% of PKP cases.
    •    Overall graft failure occurred in 20% of eyes.
  

Corneal ulcers after keratoplasty arise from both infectious and non-infectious causes and represent a significant threat to graft survival. Early identification of underlying etiology and tailored management are essential to optimize visual and anatomical outcomes.