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Study identifies factors associated with lamellar keratoplasty failure in fungal keratitis cases
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Patients treated with lamellar keratoplasty for fungal keratitis may have a significantly higher risk of failure if Aspergillus species caused the infection, if they show the presence of hypopyon or endothelial plaque before surgery, or if they receive glucocorticoids or immunosuppressants postoperatively, according to a study by researchers in China.
"Prompt recognition and management of failed [lamellar keratoplasty] with [penetrating keratoplasty] can achieve successful outcomes," the authors said.
Lixin Xie, MD, and colleagues at Shandong Eye Institute in Qingdao investigated risk factors for failure of lamellar keratoplasty in 218 eyes of 218 patients. All cases had fungal keratitis that had failed to respond to medical therapy.
All eyes received antifungal drugs for at least 7 days before surgery.
Surgeons used a trephine with a diameter that was 0.5 mm larger than the fungal infection to create the lamellar keratoplasty incisions and excise the ulcers, according to the study.
Overall, 17 patients (7.8%) experienced treatment failure within 2 weeks after lamellar keratoplasty, including 15 patients who failed within 1 week postop.
Any cases of treatment failure subsequently underwent PK, the authors noted.
"All cases of treatment failure displayed increasing local irritation and hyphal infiltration in the recipient [lamellar keratoplasty] bed and subsequently were cured by PK," they said.
"A higher rate of inadequate treatment with [lamellar keratoplasty] 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 [lamellar keratoplasty]," the authors noted.
The study is published in the January issue of Ophthalmology.