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    Why infections related to PK require intense vigilance

    Case study highlights risks in contact lens-related Pseudomonas corneal ulcer

     

    Microbial keratitis can arise from a contaminated donor button, although Dr. Jeng said that is happening much less frequently.

    However, surgeons should also be aware of the increasing risk of fungal infections (some transmitted from the donor) compared with bacterial infections, based on data from the Eye Bank Association of America, Dr. Jeng said.

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    “One possible reason for the rise in fungal infections is that endothelial keratoplasty is on the rise, and fungus love living in that interface because they are protected,” he said.

    Something that he does see more often is the recurrence of a host infection, which could be modulated by the use of certain postoperative medications like steroids. Late infections could be caused by suture-related problems, persistent epithelial defects, chronic use of bandage contact lenses, ocular surface disease, and eyelid and adnexal abnormalities.

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    “We need to identify these infections very early on and culture them,” Dr. Jeng said. “Any small infection in the graft needs to be treated aggressively.”

    He prefers to use fortified antibiotics because of the risk of graft wound dehiscence if the infection progresses.

    “I’ll decrease steroids if they’re on it,” Dr. Jeng said. “If a suture is involved, I’ll remove it. If it’s necessary to regraft, I’ll do it.”

    Although there is less risk nowadays for viral infections, it still is possible for patients to get a recurrent or new onset herpetic infection transmitted from the donor, Dr. Jeng said.

    There were previous reported cases of hepatitis B transmission, but with stringent eye bank screening in the last few decades, this infection seems to be a thing of the past. And fortunately, there have been no documented cases of HIV transmission via a graft to date, Dr. Jeng said.

     

    More articles:

    Ocular surface unfriendly to pathogenic bacteria

    Pre-existing glaucoma poses considerations for corneal procedures

    In-office treatments for MGD may provide relief

    Binkhorst Lecture: Predicting, treating keratoconus in 2016

     

    Bennie H. Jeng, MD

    E: [email protected]

    This article was adapted from Dr. Jeng’s presentation at the 2015 meeting of the American Academy of Ophthalmology. Dr. Jeng did not indicate any proprietary interest in the subject matter.

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