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Microbial keratitis in corneal grafts: Predisposing factors and outcomes

Lookup NU author(s): Arthur Okonkwo, Dr Jeffry Hogg, Hamed Anwar, Professor Francisco FigueiredoORCiD

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Abstract

© 2018 Macmillan Publishers Limited, part of Springer Nature. All rights reserved. PurposeTo identify the nature of microbial keratitis in corneal grafts and the clinical outcomes at a tertiary hospital in the United Kingdom.Patients and methodsA retrospective case series of microbial keratitis in corneal grafts at the Royal Victoria Infirmary, Newcastle upon Tyne over a 17-year period (1997-2014).ResultsA total of 759 consecutive corneal grafts were identified from the Cornea Transplantation database. Of these, 59 episodes of microbial keratitis occurred in 41 eyes of 41 patients (5.4%; 19 male, 46.3%). Median patient age was 73 years (SD=19.4 years). The most common indication for corneal transplantation was bullous keratopathy (11/41, 26.8%). There were 34/59 (57.6%) episodes of culture-positive graft keratitis; Streptococcus pneumoniae and Staphylococcus aureus were each isolated in 5/34 (14.7%) culture-positive episodes. In all, 35/59 (59.3%) episodes of microbial keratitis occurred in 22 previously failed grafts and 3 de novo graft failures. Gram-negative keratitis was more likely to cause reduced BCVA after (Χ2-test, P=0.02). Median graft duration was 49.5 months (SD=43.7 months). Failed grafts were significantly older (median 69 vs 27 months, P=0.009).ConclusionThis represents the longest published follow-up data on microbial keratitis and is the only of its kind in the United Kingdom. The incidence of 5.4% is comparable to that within the developed world. Graft age was significantly associated with graft failure in microbial keratitis; the ongoing risk of microbial keratitis warrants providing patients with long-term open access to hospital eye services.

Publication metadata

Author(s): Okonkwo ACO, Siah WF, Hogg HDJ, Anwar H, Figueiredo FC

Publication type: Article

Publication status: Published

Journal: Eye

Year: 2018

Volume: 32

Issue: 4

Pages: 775-781

Online publication date: 26/01/2018

Acceptance date: 18/11/2017

ISSN (print): 0950-222X

ISSN (electronic): 1476-5454

Publisher: Nature Publishing Group

URL: https://doi.org/10.1038/eye.2017.310

DOI: 10.1038/eye.2017.310

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