Abstract

Volume.125 Number.1

Original article : Clinical science

Comparative Investigation of Corneal Infection after Descemet Stripping Automated Endothelial Keratoplasty and Penetrating Keratoplasty
Hiroaki Oku1, Koichi Wakimasu1, Osamu Hieda2, Taisuke Imura2, Hideki Fukuoka2, Toshihide Yamasaki1, Tsutomu Inatomi2,3, Norihiko Yokoi2, Chie Sotozono2, Shigeru Kinoshita1,4
1 Baptist Eye Institute
2 Department of Ophthalmology, Kyoto Prefectural University of Medicine
3 National Center for Geriatrics and Gerontology
4 Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine

Purpose: To comparatively investigate postoperative corneal infection after Descemet stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PKP).
Subjects and methods: The subjects comprised the ones who had undergone corneal transplant surgery between August 2007 and September 2018 at the Baptist Eye Institute, Kyoto, Japan, and could be observed for at least 1 year postoperatively. We retrospectively investigated the incidence of post-transplant infections, microbial etiology (excluding viral infections such as herpes), time of onset, site of infection, use of topical steroids at time of onset, and prognosis.
Results: In this study, 639 post-DSAEK eyes and 616 post-PKP eyes were considered. The mean postoperative observation period was 51.4±20.8 months (mean±standard deviation) for post-DSAEK eyes and 57.3±32.3 months for post-PKP eyes. Postoperative corneal infection occurred in 11 post-DSAEK eyes (1.7%) and in 39 (6.3%) post-PKP eyes. The incidence was significantly lower for post-DSAEK eyes than for post-PKP eyes (p<0.001). Of the post-DSAEK eyes, the cause was bacterial infection in 1 eye, fungus in 8 eyes, and the cause was not detected in 2 eyes. Of the post-PKP eyes, the infection was caused by bacteria in 11 eyes, fungus in 18 eyes, and the cause was not detected in 10 eyes. Postoperative onset occurred at 24.9±25.4 months for the post-DSAEK eyes and at 36.9±34.8 months for the post-PKP eyes (p=0.23). Of the post-DSAEK eyes, the site of infection was the epithelium only in 4 eyes, the epithelium and parenchyma in 5 eyes, and the parenchyma only in 2 eyes. Of the post-PKP eyes, the site of infection was only the epithelium in 6 eyes and both the epithelium and parenchyma in 33 eyes. At onset, 0.1% fluorometholone was topically administered to 4 post-DSAEK eyes and 18 post-PKP eyes, whereas 0.1% betamethasone was topically administered to 7 post-DSAEK eyes and 21 post-PKP eyes. Vision loss of two or more lines when compared with prior to onset of infection after healing with conservative treatment was confirmed in 4 post-DSAEK eyes (40.0%) and in 19 post-PKP eyes (51.4%) (p=0.39).
Conclusion: Postoperative infection incidence was lower in post-DSAEK cases than in post-PKP cases.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 125: 22-29, 2021.

Key words
Descemet stripping automated endothelial keratoplasty, Penetrating keratoplasty, Corneal infection, Keratomycosis, Suture-related infection
Reprint requests to
Hiroaki Oku, M. D.　Baptist Eye Institute. 12 Kamiikeda-cho, Kitashirakawa, Sakyo-ku, Kyoto 606-8287, Japan
Received: 22 May 2020. Accepted in revised form: 21 August 2020.
Nihon Ganka Gakkai Zasshi 125: 22-29,2021