Diagnosis of asymptomatic “cold” infection in decompensated full-thickness corneal grafts

Session Details

Session Title: Inflammation in Ocular Infections

Session Date/Time: Wednesday 17/09/2014 | 08:00-09:30

Paper Time: 09:06

Venue: Capital Hall A

First Author: : B.Ricci Filipovic ITALY

Co Author(s): :    Y. Nahum   A. Caimi   S. Demontis   M. Busin     

Abstract Details

Purpose:

To describe a series of eyes with asymptomatic infections of decompensated full-thickness grafts diagnosed by means of histologic examination and cultures performed on the buttons excised at the time of repeat penetrating keratoplasty (PK).

Setting:

Retrospective case series of all consecutive repeat PK procedures performed at a private hospital during the last 3 years by the same surgeon (MB).

Methods:

Review of all the medical records of patients undergoing repeat PK since January 2011, including the histologic results of the excised corneal buttons. Patient history, visual acuity, slit lamp examination results, histologic and bacteriologic results and slit-lamp photos were recorded . Outcome measures include positive histology or cultural examination for microorganisms, recurrence of infection after repeat PK, graft clarity.

Results:

Thirty-two repeat PK procedures were performed at or Institution from January 2011 till December 2013. All patients had been referred because of old-standing graft decompensation with stromal scars, none because of infection. No patients presented with pain or discomfort and preoperative slit-lamp examination did not reveal any signs of inflammation despite the occasional presence of an epithelial defect and various finding suggestive of possible infection (corneal infiltrate n=3; descemetocele and infiltrate n=1; crystalline keratopathy n=1; elevated pigmented central infiltrate n=1). Histologic examination confirmed the presence of an infectious infiltrate in the 6 eyes with slit-lamp suspicious findings (staphylococcus n=2; Candida n= 2; Actynomices n=1; Streptococcus = 1). Cultures were positive only in 3 cases (Staphylococcus Aureus n=1; Candida Albicans n=1; Streptococcus Agalactiae n=1). Recurrence of infection after repeat PK was seen in 2 cases, which were eventually managed successfully with long-term topical antibiotic treatment. All 6 grafts performed in infected eyes were clear at the time of this review (follow-up = 3 to 28 months).

Conclusions:

Post keratoplasty patients with failed grafts can present with asymptomatic, slow-growing infectious keratitis in apparently quiet eyes. High index of suspicion and good photographic documentation are important for the diagnosis of this condition. However, histologic examination of the excised buttons is instrumental in determining the proper diagnosis, while cultural examination may prove negative (50% of cases in our series).

Financial Interest:

One or more of the authors... travel has been funded, fully or partially, by a competing company