Abstract Title
Incidence, Causative Pathogens, Risk Factors, Geographical Variations, and Outcomes of Post-Keratoplasty Infectious Keratitis Over the Last 15 Years: A Systematic Review and Meta-Analysis
Introduction & Objectives
Cornea with prior keratoplasty has been associated with an increased risk of infectious keratitis (IK). Over the last 15 years, the trend in keratoplasty surgery has shifted from penetrating keratoplasty to endothelial keratoplasty, which might considerably affect the occurrence of post-keratoplasty infectious keratitis (PKIK). We aim to assess the incidence, risk factors, causative microorganisms, and outcomes of PKIK, considering the differences in the type of keratoplasty and potential geographical variations.
Methods
Electronic searches were conducted in four databases (PubMed/MEDLINE, Cochrane, Scopus, and Wiley) for studies reporting PKIK from 2009 to 2024. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.
Results
Eight studies were eligible for final analysis. The incidence of PKIK ranged from 1.80% to 18.77%. Compared to penetrating keratoplasty endothelial keratoplasty showed a trend towards a lower risk of PKIK (log odds ratio -1.33, 95% CI: -2.96 – 0.30, p = 0.108). While gram-positive bacteria were the most common pathogens found to cause PKIK, it was estimated that 21% (95% CI: 9-33%) of cases were attributed to fungal infections. The influence of the geographical study site on thefungal proportion was not significant in meta-regression analysis (p > 0.05). Several risk factors for PKIK were also identified. Severe visual impairment was commonly observed following treatment of PKIK. Topical quinolone can be used as first-line therapy despite the increasing antibiotic resistance rate of pathogens.
Conclusion
Endothelial keratoplasty showed a trend towards a lower incidence of PKIK compared to penetrating keratoplasty. PKIK remains a devastating complication after keratoplasty.
Keyword
Corneal transplant, penetrating keratoplasty, endothelial keratoplasty, infection, keratitis, incidence