Royal Victorian Eye and Ear Hospital, Australia, Centre for Eye Research Australia, University of Melbourne, Victoria, Australia.
Am J Ophthalmol. 2013 Feb;155(2):233-237.e2. doi: 10.1016/j.ajo.2012.07.026. Epub 2012 Oct 27.
To comparatively evaluate the clinical and microbiological profiles and treatment outcome of cases with post-penetrating keratoplasty (PK) infectious keratitis in failed and clear grafts.
Retrospective, matched cohort study.
All cases of infectious keratitis following penetrating keratoplasty admitted to the Royal Victorian Eye and Ear Hospital, Melbourne, between January 1998 and December 2008 were identified through a retrospective medical chart review. Cases without any surface sutures were selected and divided into 2 groups, microbial keratitis with pre-existing graft failure and microbial keratitis in clear graft on presentation. Demographic, clinical, and microbiological profiles of cases in both groups were analyzed and compared.
Patients in the failed-graft group were older (P = .004) and had an early onset of graft infection (P = .049), compared with patients in the clear-graft group. All patients in the failed-graft group were on long-term corticosteroid drops at the time of presentation (vs 76% in clear-graft group; P = .005). Moraxella sp was more frequently isolated in the failed-graft group (30.4%) compared with the clear-graft group (8%). A higher number of cases in the clear-graft group required surgical intervention in the form of corneal gluing and therapeutic corneal transplantation compared with the failed-graft group (P = .03).
Prolonged use of corticosteroid eye drops is a major risk factor for the occurrence of postkeratoplasty infectious keratitis in failed and clear grafts. Infections in failed grafts occur earlier as compared to clear grafts, and indolent organisms like Moraxella are prevalent in patients with failed grafts in Australia.
比较分析穿透性角膜移植术后（PKP）感染性角膜炎在失败和透明移植物中的临床和微生物学特征及治疗效果。
回顾性、匹配队列研究。
通过回顾性病历审查，确定 1998 年 1 月至 2008 年 12 月期间在墨尔本皇家维多利亚眼耳医院就诊的所有穿透性角膜移植术后感染性角膜炎病例。选择无任何表面缝线的病例，并将其分为 2 组，即术前存在移植物失败的微生物性角膜炎和初次就诊时透明移植物的微生物性角膜炎。分析和比较两组病例的人口统计学、临床和微生物学特征。
与透明移植物组相比，失败移植物组患者年龄较大（P=0.004），移植物感染发病较早（P=0.049）。所有失败移植物组患者在就诊时均长期使用皮质类固醇滴眼剂（与透明移植物组的 76%相比；P=0.005）。失败移植物组中更常分离出莫拉氏菌属（30.4%），而透明移植物组中则为 8%。与失败移植物组相比，透明移植物组中更多的病例需要进行角膜胶合和治疗性角膜移植等手术干预（P=0.03）。
长期使用皮质类固醇滴眼剂是导致失败和透明移植物发生 PKP 后感染性角膜炎的主要危险因素。与透明移植物相比，失败移植物中的感染发生得更早，而澳大利亚失败移植物患者中常见莫拉氏菌等慢性病原体。
