Outcome of therapeutic keratoplasty in fungal keratitis - PowerPoint PPT Presentation

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Outcome of therapeutic keratoplasty in fungal keratitis

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Outcome of therapeutic keratoplasty in fungal keratitis Sonika Gupta, MS Assistant Professor, GMCH, Chandigarh, India Author has no financial interest – PowerPoint PPT presentation

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Title: Outcome of therapeutic keratoplasty in fungal keratitis


1
Outcome of therapeutic keratoplasty in fungal
keratitis
  • Sonika Gupta, MS
  • Assistant Professor,
  • GMCH, Chandigarh, India
  • Author has no financial interest

2
Purpose of Study
  • To study the outcome of therapeutic penetrating
    keratoplasty (TPK) in fungal keratitis, which is
    a major cause of corneal blindness in our set-up.

3
Cases of fungal keratitis
Fungal plaque with hypopyon
Feathery margins
Corneal abscess
Infitrates with pigmentation
4
Methods
  • ? A prospective database on 44 therapeutic
    keratoplasties in 44 patients of fungal keratitis
    recorded the following data-demographic details
    on age and gender of the patient, indication for
    surgery, size of donor and recipient bed
    causative organism and complications.
  • Indications for surgery -fungal keratitis not
    responding to maximal medical therapy,
    desmetocele with infiltrates, or a perforation of
    more than 2 mm in the presence of active
    inflammation.
  • All patients underwent TPK by a similar method
    -a donor button oversized by 0.5 mm and 16 bites
    of interrupted sutures with 10-0 monofilament
    nylon.

5
Methods
  • Minimum follow-up period was 1 year.
  • Excised host cornea was sent for microbiologic
    and histopathologic examination.
  • Outcomes were evaluated in terms of anatomical
    success, graft clarity and visual acuity.
  • ? Effect of graft size, causative organism and
    perforation on the final outcome was analyzed.
  • Statistical analysis Chi-square tests were
    performed for categorical variables.
  • A p-value of 0.05 was considered significant.

6
Results
  • Mean age of patients was 45.98 18.23 years
    (range 14-80 years). 30 males, 14 females.
  • Thirteen eyes had perforation at presentation.
  • Mean graft diameter was 9.0 mm (range 7.5 -11
    mm)
  • Isolates identified were Aspergillus (50),
    Fusarium (36),Candida (9.0) and Curvularia
    (4.5).

7
Results
  • Anatomical success seen in 42 eyes (95.4).
  • Grafts in 18 eyes (40.9) remained clear during
    follow-up.
  • Visual acuity 20/200 achieved in 9 eyes
    (20.4).
  • Graft size, species of organism and perforation
    did not significantly affect anatomical success
    and visual outcome.
  • Graft size significantly correlated with graft
    clarity (p 0.0016 chi- square test).
  • No correlation was found between perforation and
    organism species with graft clarity (p0.39).

8

Clear graft after TPK
Fungal corneal abscess

9
Complications after TPK in fungal
keratitis
10
Complications after TPK in fungal
keratitis
Graft infection
Persistent epithelial defect
Graft failure
11
Discussion
  • Xie et al Br J Ophthalmol 2001
  • Retrospective analysis of 108 cases
  • Corneal grafts clear in 86 eyes (79.6).
  • Complications graft rejection (29.6),
    reinfection (7.4), cataract (4.6).
  • Vision better than 20/60 was seen in 26.8 of
    eyes.
  • Ti et al American J Ophthalmol May 2007
  • TPK in fungal keratitis n31
  • Fusarium sp.(32.3) predominant causative
    organism.
  • One year therapeutic survival 72.4.

12
Conclusion
  • TPK is successful in maintaining the ocular
    integrity in most eyes with fungal keratitis.
  • Lower number of clear grafts in our study
    could be due to
  • Delay in presentation by the patient leading to
    delayed surgical intervention
  • Lack of availability of good quality donor
    tissue.
  • Inadequate compliance with follow-up.
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