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  • Title: Therapeutic Corneal Transplant for Fungal Keratitis Refractory to Medical Therapy.
    Author: Barut Selver O, Egrilmez S, Palamar M, Arici M, Hilmioglu Polat S, Yagci A.
    Journal: Exp Clin Transplant; 2015 Aug; 13(4):355-9. PubMed ID: 25247377.
    Abstract:
    OBJECTIVES: To report the outcomes of therapeutic corneal transplant for managing fungal keratitis that is refractory to medical treatment. MATERIALS AND METHODS: Retrospective data analyses of the medical records was performed on 17 patients who underwent a therapeutic corneal transplant for severe culture-proven fungal keratitis between October 2006 and August 2013. We evaluated demographics, fungal organism type, surgical data, recurrence presentation, disease course, follow-up, and graft status. RESULTS: Mean patient age was 53.2 years (range, 33-81 y). The male/female ratio was 12/5. All patients had positive microscopic evaluation and positive culture results for fungal infection. The most common fungal agent was Fusarium sp. (35%). Nine patients reported a history of injury to the cornea and/or contact with plant material or soil. The mean best-corrected visual acuity at the initial visit was 2.45 logMAR unit (range, 0.52-3.10 logMAR unit). The mean follow-up was 14 months (range, 6-76 mo). Four patients underwent evisceration surgery because of graft lysis or uncontrolled recurrent disease. Recurrence of the fungal infection after corneal transplant was seen in 8 patients (47.05%). The graft rejection rate was 18.18%. At the final visit, 5 grafts were clear, 4 were translucent, and 2 were opaque. There were 2 phthisis bulbi owing to catastrophic disease. The mean final best-corrected visual acuity was 1.64 logMAR unit (range, 0.22-3.10 logMAR unit). CONCLUSIONS: Although therapeutic corneal transplant has a higher incidence of infection recurrence and graft failure, it continues to be an effective treatment for uncontrolled, refractory fungal keratitis cases to save the affected eye.
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