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Abstract：
Post-keratoplasty infectious keratitis (PKIK) is a unique sight-threatening clinical entity which often poses significant therapeutic challenges. This study aimed to examine the clinical presentation, risk factors, management, and clinical outcomes of PKIK.
This was a retrospective study of all patients who presented to the Queen\'s Medical Centre, Nottingham, with PKIK between September 2015 and August 2022 (a 7-year period). Relevant data on types of keratoplasty, clinical presentations, causative microorganisms, management, and outcome were analyzed.
Forty-nine PKIK cases, including four cases of interface infectious keratitis, were identified during the study period. The most common graft indications for PKP, DALK and EK were failed grafts (9, 37.5%), keratoconus (6, 54.5%) and Fuchs endothelial corneal dystrophy (FECD; 8, 57.1%), respectively. Staphylococcus spp. were the most commonly identified organisms (15, 50.0%). Bullous keratopathy (18, 36.7%), ocular surface disease (18, 36.7%), and broken/loose sutures (15, 30.6%) were the most common risk factors. Concurrent use of topical steroids was identified in 25 (51.0%) cases. Of 31 functioning grafts at presentation, 12 (38.7%) grafts failed at final follow-up with 15 (48.4%) patients retaining a CDVA of ≥1.0 logMAR. The overall estimated 5-year survival rate post-PKIK was 55.9% (95% CI, 35.9%-75.9%), with DALK having the highest survival rate [63.6% (95% CI, 28.9%-98.3%)], followed by EK [57.1% (95% CI, 20.4%-93.8%)] and PKP [52.7% (95% CI, 25.1%-80.3%)], though no statistical difference was observed (p=0.48).
PKIK represents an important cause of IK and graft failure. Bullous keratopathy, OSD and suture-related complications are the commonest risk factors, highlighting the potential benefit of prophylactic topical antibiotics (for unhealthy ocular surface) and early suture removal (where possible) in reducing the risk of PKIK. Graft survival may be higher in lamellar keratoplasty following PKIK but larger studies are required to elucidate this observation.
This was a retrospective study of all patients who presented to the Queen\'s Medical Centre, Nottingham, with PKIK between September 2015 and August 2022 (a 7-year period). Relevant data on types of keratoplasty, clinical presentations, causative microorganisms, management, and outcome were analyzed.
Forty-nine PKIK cases, including four cases of interface infectious keratitis, were identified during the study period. The most common graft indications for PKP, DALK and EK were failed grafts (9, 37.5%), keratoconus (6, 54.5%) and Fuchs endothelial corneal dystrophy (FECD; 8, 57.1%), respectively. Staphylococcus spp. were the most commonly identified organisms (15, 50.0%). Bullous keratopathy (18, 36.7%), ocular surface disease (18, 36.7%), and broken/loose sutures (15, 30.6%) were the most common risk factors. Concurrent use of topical steroids was identified in 25 (51.0%) cases. Of 31 functioning grafts at presentation, 12 (38.7%) grafts failed at final follow-up with 15 (48.4%) patients retaining a CDVA of ≥1.0 logMAR. The overall estimated 5-year survival rate post-PKIK was 55.9% (95% CI, 35.9%-75.9%), with DALK having the highest survival rate [63.6% (95% CI, 28.9%-98.3%)], followed by EK [57.1% (95% CI, 20.4%-93.8%)] and PKP [52.7% (95% CI, 25.1%-80.3%)], though no statistical difference was observed (p=0.48).
PKIK represents an important cause of IK and graft failure. Bullous keratopathy, OSD and suture-related complications are the commonest risk factors, highlighting the potential benefit of prophylactic topical antibiotics (for unhealthy ocular surface) and early suture removal (where possible) in reducing the risk of PKIK. Graft survival may be higher in lamellar keratoplasty following PKIK but larger studies are required to elucidate this observation.
摘要：
角膜移植术后感染性角膜炎（PKIK）是一种独特的视力威胁临床实体，通常会带来重大的治疗挑战。本研究旨在检查临床表现，危险因素，管理,和PKIK的临床结果。
这是对所有到女王医疗中心就诊的患者的回顾性研究，诺丁汉,在2015年9月至2022年8月期间使用PKIK（为期7年）。角膜移植术类型的相关数据，临床表现,致病微生物,管理,并对结果进行了分析。
■49例PKIK，包括4例界面感染性角膜炎，是在研究期间确定的。PKP最常见的移植物适应症，DALK和EK移植失败（9，37.5％），圆锥角膜（6，54.5%）和Fuchs内皮角膜营养不良（FECD；8，57.1%），分别。葡萄球菌属。是最常见的生物(15，50.0%)。大疱性角膜病变（18，36.7%），眼表疾病（18，36.7%），断裂/松动缝线（15，30.6%）是最常见的危险因素。在25例（51.0％）病例中同时使用局部类固醇。在展示时31个功能正常的移植物中，最终随访时，有12例（38.7％）移植物失败，其中15例（48.4％）患者的CDVA≥1.0logMAR。PKIK后的总体估计5年生存率为55.9％（95％CI，35.9％-75.9％），DALK的存活率最高[63.6%（95%CI，28.9%-98.3%）]，其次是EK[57.1%(95%CI，20.4%-93.8%)]和PKP[52.7%(95%CI，25.1%-80.3%)]，尽管没有观察到统计学差异（p=0.48）。
■PKIK代表了IK和移植物失败的重要原因。大疱性角膜病变,OSD和缝合相关并发症是最常见的危险因素，强调预防性局部用抗生素（用于不健康的眼表）和早期缝线移除（如果可能）在降低PKIK风险方面的潜在益处。PKIK后板层角膜移植术的移植物存活率可能更高，但需要更大规模的研究来阐明这一观察结果。
这是对所有到女王医疗中心就诊的患者的回顾性研究，诺丁汉,在2015年9月至2022年8月期间使用PKIK（为期7年）。角膜移植术类型的相关数据，临床表现,致病微生物,管理,并对结果进行了分析。
■49例PKIK，包括4例界面感染性角膜炎，是在研究期间确定的。PKP最常见的移植物适应症，DALK和EK移植失败（9，37.5％），圆锥角膜（6，54.5%）和Fuchs内皮角膜营养不良（FECD；8，57.1%），分别。葡萄球菌属。是最常见的生物(15，50.0%)。大疱性角膜病变（18，36.7%），眼表疾病（18，36.7%），断裂/松动缝线（15，30.6%）是最常见的危险因素。在25例（51.0％）病例中同时使用局部类固醇。在展示时31个功能正常的移植物中，最终随访时，有12例（38.7％）移植物失败，其中15例（48.4％）患者的CDVA≥1.0logMAR。PKIK后的总体估计5年生存率为55.9％（95％CI，35.9％-75.9％），DALK的存活率最高[63.6%（95%CI，28.9%-98.3%）]，其次是EK[57.1%(95%CI，20.4%-93.8%)]和PKP[52.7%(95%CI，25.1%-80.3%)]，尽管没有观察到统计学差异（p=0.48）。
■PKIK代表了IK和移植物失败的重要原因。大疱性角膜病变,OSD和缝合相关并发症是最常见的危险因素，强调预防性局部用抗生素（用于不健康的眼表）和早期缝线移除（如果可能）在降低PKIK风险方面的潜在益处。PKIK后板层角膜移植术的移植物存活率可能更高，但需要更大规模的研究来阐明这一观察结果。
