Therapeutic Penetrating Keratoplasty For Refractory Infectious Keratitis In A Tertiary Eye Care Center In Sweden

To investigate indications, complications and tectonic, therapeutic and functional success in cases with advanced medically uncontrolled infectious keratitis treated with Therapeutic Penetrating Keratoplasty (TPK)

Cornea Service, Örebro Ophthalmology Clinic, Örebro University, Sweden 

Fourteen cases of serious infectious keratitis unresponsive to medical therapy who treated with TPK between 2012 and 2024 at Örebro Opthalmology Clinic with at least 12 months follow up were reviewed retrospectively. Age at surgery, causative microorganism, time between diagnosis and surgery, eventual perforation, complications and preoperative and postoperative visual acuity. The relationship between these findings and anatomic, therapeutic, and functional success was evaluated as well.   

A total of 14 eyes of 12 patients (2 underwent repeated keratoplasty due to recurrence) with an age range of 57 to 89 years at surgery who underwent TPK were included. Nine cases were diagnosed with mycotic keratitis, 4 with bacterial keratitis and 1 with acanthamoeba keratis. Mean time between diagnosis and surgery was 11 days. Perforation was observed in 5 cases (35 %). Anatomical success was obtained in all 14 cases, whereas therapeutic and optical success was observed in 12 cases (85 %). BCVA was preop ≤20/4000 and at 12 mo postop was ≥20/200 in 7 eyes (58 %) and ≥20/40 in 3 eyes (25 %). The most frequent postop complications were loose sutures, persistent erosion and inflammation. Both 2 recurrent cases were diagnosed with fungi (14%).

This study shows that TPK in refractory infectious keratitis, although more prone to complications compared to optic PK, may be an effective treatment option which offer high rates of tectonic integrity, eradication of causative infection and some visual rehabilitation. The most frequent causative microorganisms were fungi, especially candida which was responsible for recurrence.