Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, Telangana, India.
Indian J Ophthalmol. 2019 Oct;67(10):1599-1605. doi: 10.4103/ijo.IJO_1952_18.
To study the outcomes of therapeutic penetrating keratoplasty in fungal keratitis.
This retrospective, observational, interventional case series involved an audit of 198 consecutive eyes that underwent therapeutic penetrating keratoplasty (ThPK) for fungal keratitis at L V Prasad Eye Institute between January 2008 and December 2010 was performed. The data on demographics, clinical characteristics, intraoperative, and late postoperative complications were noted. The primary outcome measure was eradication of infection and postoperative anatomical success. Secondary outcome measures were graft survival, risk factors, clinical features, and management of recurrent fungal keratitis post ThPK.
Mean follow-up after ThPK was 24 ± 17 months. A total of 178 (89.9%) eyes had complete eradication of fungal infection, whereas 20 (10.1%) eyes developed recurrence. Anatomical restoration was achieved in majority of cases (192 eyes; 97%). Larger infiltrate size was associated with a higher risk of recurrence of infection. The median graft survival rate was 5.9 months. The graft survival was better for grafts <8 mm versus those with >8 mm (P = 0.026) and not found significantly related to the species of fungus. Twenty-seven eyes underwent re-grafting: penetrating keratoplasty in 14 eyes, and Descemet's stripping endothelial keratoplasty in 13 eyes.
As larger infiltrate prior to therapeutic keratoplasty had much higher risk of recurrences; timely surgical intervention should be considered in cases not responding to medical therapy. Alternative strategies of management of postoperative inflammation need to be considered to prevent graft failures.
研究治疗性穿透性角膜移植术治疗真菌性角膜炎的结果。
本回顾性、观察性、干预性病例系列研究对 2008 年 1 月至 2010 年 12 月期间在 LV Prasad 眼科研究所接受治疗性穿透性角膜移植术（ThPK）治疗真菌性角膜炎的 198 例连续眼进行了审核。记录了人口统计学、临床特征、术中及晚期术后并发症的数据。主要观察指标是感染的消除和术后解剖学成功。次要观察指标是移植物存活率、危险因素、临床特征和 ThPK 后复发性真菌性角膜炎的处理。
ThPK 后平均随访时间为 24 ± 17 个月。共有 178 只（89.9%）眼完全消除了真菌感染，而 20 只（10.1%）眼发生了复发。大多数病例（192 只眼；97%）实现了解剖学恢复。较大的浸润大小与感染复发的风险增加相关。中位移植物存活率为 5.9 个月。<8mm 的移植物存活率优于>8mm 的移植物（P=0.026），与真菌种类无显著关系。27 只眼接受了再次移植：14 只眼行穿透性角膜移植术，13 只眼行 Descemet 膜内皮角膜移植术。
由于治疗前较大的浸润更有可能复发；对于未对药物治疗产生反应的病例，应考虑及时进行手术干预。需要考虑替代的术后炎症管理策略，以防止移植物失败。
