Infectious keratitis in the corneal graft: treatment with partial conjunctival flaps

Abstract

Background and objective: The infection of the corneal graft is one of the most serious complications following keratoplasty. In many instances, it can be treated successfully with intensive topical and subconjunctival antibiotics. However, when this therapy is ineffective, a surgical approach must be considered. The usefulness of partial conjunctival flaps that spare the visual axis for managing corneal graft infections is reported.

Patients and methods: Retrospective review of four cases. All patients were males between 12 and 85 years old. The four abscesses developed in the penetrating corneal graft during the first year after keratoplasty. The organisms found were Propionibacterium acnes, Candida albicans, Staphylococcus aureus, and Streptococcus pneumoniae. After failure of medical therapy, they were operated on using the partial, thick conjunctival flap technique.

Results: Resolution of the infection and maintenance of a clear graft was achieved in all patients. The follow-up ranged from 5 to 8 years.

Conclusion: The partial conjunctival flap is an effective surgical procedure for the treatment of abscesses in penetrating keratoplasties when medical treatment has failed.