Corneal Graft Infections

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

An ambispective observational study was conducted at a tertiary eye care centre in India from January 2023 to June 2025. The study evaluated patients who developed graft infections following keratoplasty during the study period.

Fifty-eight cases of post-keratoplasty graft infection were included (44 penetrating, 7 anterior lamellar, 7 endothelial). Demographic details, clinical characteristics, donor variables, and microbiological profiles were analyzed using retrospective and prospective data collection.

The median epithelial defect size was 4 × 4.5 mm² and infiltrate size was 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. Smaller grafts were associated with bacterial graft infections.

Corneal graft infections were frequently associated with loose sutures, topical steroid use, and smaller graft size. Gram-positive cocci were the predominant isolates. More than half the cases required surgical intervention, highlighting the importance of vigilant postoperative surveillance.