Sun Jen-Pin, Chen Wei-Li, Huang Jehn-Yu, Hou Yu-Chih, Wang I-Jong, Hu Fung-Rong
Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; Center of Corneal Tissue Engineering and Stem Cell Biology, National Taiwan University Hospital, Taipei, Taiwan.
Am J Ophthalmol. 2017 Jun;178:150-156. doi: 10.1016/j.ajo.2017.03.022. Epub 2017 Mar 25.
To report the incidence, microbiological profile, graft survival, and determining factors of microbial keratitis after penetrating keratoplasty (PK).
Observational case series.
The study involved 51 patients (52 eyes) who were treated at a single tertiary referral center during a 10-year period. Retrospective chart review included medical records of all patients diagnosed with microbial keratitis after penetrating keratoplasty at the National Taiwan University Hospital between January 2000 and December 2009. The main outcome measures were incidence of graft infection, microbial profile, and graft survival status.
There were 871 PKs performed and 67 episodes in 52 eyes of culture-positive microbial keratitis during the study period. There were 32 infectious episodes (47.8%) in the first year post-PK and 35 episodes (52.2%) after the first year post-PK. Forty-four gram-positive bacterial isolates (57.9%), 17 gram-negative bacterial isolates (22.4%), and 15 fungal isolates (19.7%) were found. Twenty-three (34.3%) grafts remained clear after the infection episode with a mean follow-up of 1127 days (range, 25-3962 days). There was no difference in graft survival rate regarding the original indication of PK or offending pathogen. Suture-related infection was associated with decreased risk of graft failure (P = .02), while the factor associated with increased risk of graft failure was usage of antiglaucoma agents (P = .01).
Infectious keratitis after penetrating keratoplasty leads to a high graft failure rate. Such complications can occur before or after the first year post-PK.
报告穿透性角膜移植术（PK）后微生物性角膜炎的发病率、微生物学特征、植片存活率及相关决定因素。
观察性病例系列研究。
本研究纳入了10年间在一家三级转诊中心接受治疗的51例患者（52只眼）。回顾性病历审查包括2000年1月至2009年12月期间在台湾大学医院被诊断为穿透性角膜移植术后微生物性角膜炎的所有患者的病历。主要观察指标为植片感染的发病率、微生物学特征及植片存活状态。
在研究期间共进行了871例穿透性角膜移植术，52只眼中有67例培养阳性的微生物性角膜炎发作。穿透性角膜移植术后第一年有32次感染发作（47.8%），术后第一年之后有35次发作（52.2%）。共发现44株革兰氏阳性菌分离株（57.9%）、17株革兰氏阴性菌分离株（22.4%）和15株真菌分离株（19.7%）。23例（34.3%）植片在感染发作后保持透明，平均随访1127天（范围25 - 3962天）。穿透性角膜移植术的原发病因或致病病原体对植片存活率无差异。缝线相关感染与植片失败风险降低相关（P = 0.02），而与植片失败风险增加相关的因素是使用抗青光眼药物（P = 0.01）。
穿透性角膜移植术后感染性角膜炎导致较高的植片失败率。此类并发症可发生在穿透性角膜移植术后第一年之前或之后。
