Treatment failure after lamellar keratoplasty for fungal keratitis

Abstract

Purpose: To evaluate treatment failure after lamellar keratoplasty (LK) for fungal keratitis.

Design: Retrospective, interventional case series.

Participants: Two hundred eighteen patients (218 eyes) with fungal keratitis who failed to respond to medical therapy and underwent LK at the Shandong Eye Institute between January 1998 and July 2005.

Methods: Detailed medical history was obtained from each patient. Antifungal drugs were administered for at least 7 days before LK was performed. A trephine that was 0.5 mm larger in diameter than the fungal infection was used to create a lamellar incision to excise the ulcer. After treatment failure was observed after surgery, penetrating keratoplasty (PK) was performed. The distribution of risk factors for treatment failure was analyzed.

Main outcome measures: Clinical features and risk factors for treatment failure.

Results: Seventeen patients (7.8%) experienced treatment failure within 2 weeks after LK, including 15 patients within 1 week. All cases of treatment failure displayed increasing local irritation and hyphal infiltration in the recipient LK bed and subsequently were cured by PK. A higher rate of inadequate treatment with LK was found in the cases with Aspergillus species, in those to whom glucocorticoids or immunosuppressants were administered, and in those with hypopyon or endothelial plaque before LK.

Conclusions: Treatment failure after LK for fungal keratitis can be reduced significantly with adept intraoperative skills. Aspergillus species, use of glucocorticoids or immunosuppressants, and presence of hypopyon or endothelial plaque before LK should be noted as major risk factors. Prompt recognition and management of failed LK with PK can achieve successful outcomes.