You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Interface Infection After Descemet Stripping Automated Endothelial Keratoplasty: Outcomes of Therapeutic Keratoplasty

Nahum, Yoav MD*,†,‡,§; Russo, Cataldo MD*,†; Madi, Silvana MD*,¶; Busin, Massimo MD*,†

doi: 10.1097/ICO.0000000000000205
Clinical Science

Purpose: The aim of this study was to evaluate the visual outcomes and graft survival rate after therapeutic keratoplasty performed for interface infection after Descemet stripping automated endothelial keratoplasty (DSAEK).

Methods: This is a retrospective, interventional case series. The study population comprised 7 patients who developed unilateral post-DSAEK interface infection unresponsive to conservative treatment, with or without graft exchange, and were treated with penetrating keratoplasty (PK), 9 to 9.5 mm in diameter, with en bloc excision of the recipient cornea and DSAEK graft. The main outcome measures included best spectacle-corrected visual acuity, refractive error, histological examination, reinfection, and rejection and graft survival rates.

Results: Interface infection was diagnosed in 10 (0.92%) of 1088 eyes that underwent DSAEK at our institution between 2005 and 2013. Seven of 10 eyes (0.64% of the total) were unresponsive to conservative treatment and underwent therapeutic keratoplasty. Candida and Staphylococcus species were identified in 3 cases each, and Nocardia species was identified in 1 case. With a mean post-PK follow-up of 25.4 months (range 4–60 months), no recurrence of infection was seen in any eye, and 5 of 7 PK grafts remained clear. Best spectacle-corrected visual acuity was 20/20 in 2 eyes, better than 20/50 in 4 eyes, and 20/100 or worse in 3 eyes, in 2 of which the graft had failed within 1 year of performing the PK.

Conclusions: Therapeutic keratoplasty is instrumental in eliminating interface infection after DSAEK, possibly leading to excellent visual outcomes with a relatively high graft survival rate.

Author Information

*Department of Ophthalmology, “Villa Igea” Hospital, Forli, Italy;

Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forli, Italy;

Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel;

§Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and

University of Alexandria, Alexandria, Egypt.

Reprints: Massimo Busin, MD, Department of Ophthalmology, “Villa Igea” Hospital, Viale Gramsci 42, 47122 Forli, Italy (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received May 14, 2014

Accepted June 10, 2014

© 2014 by Lippincott Williams & Wilkins.