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Incidence, Occurrence Rate, and Characteristics of Suture-Related Corneal Infections After Penetrating Keratoplasty

Hood, Christopher T MD; Lee, Brian J MD; Jeng, Bennie H MD

doi: 10.1097/ICO.0b013e3182041755
Clinical Science

Purpose: To report the incidence, occurrence rate, and characteristics of suture-related infections after penetrating keratoplasty (PK).

Methods: Patients who underwent PK at our institution between January 1, 2002, and July 1, 2006, were cross-referenced with patients diagnosed with corneal infections between January 1, 2002, and July 1, 2007. All patient charts were reviewed retrospectively for occurrence of suture-related infections, duration of follow-up, and clinical characteristics.

Results: Of the 487 PKs performed in 412 patients, 22 eyes of 22 patients developed postoperative corneal infections. Of these, 5 eyes were identified as having suture-related graft infections, yielding an occurrence rate of 1.0%. The average follow-up was 3.46 years per PK, yielding an incidence of 2.96 infections per 1000 PK-years. The mean interval from surgery to infection was 8 months (range: 3-23 months). All culprit sutures were in the interpalpebral zone. No patients were using topical antibiotics at the time of infection, and all patients were using topical corticosteroid drops. Cultured organisms included Staphylococcus aureus (3 cases), coagulase-negative Staphylcoccus (1 case), and S. viridans (1 case). In 2 patients with isolated corneal involvement, topical moxifloxacin was initiated, and the patients responded favorably. In 3 patients with corneal infection and an associated hypopyon or endophthalmitis, vitreous biopsy, intravitreal injections of antibiotics, and fortified topical antibiotics were used. One patient required a repeat PK as a result of the infection. Two eyes eventually became phthisical.

Conclusions: The rate of suture-related infections after PK may be lower than previously reported. In our patients, suture-related infections all occurred within the first 2 years after surgery, and some of them resulted in significant morbidity, underscoring the importance of patient identification of symptoms and early clinical recognition.

From the Cole Eye Institute, Cleveland Clinic, Cleveland, OH.

Received for publication December 5, 2008; revision received May 1, 2009; accepted May 10, 2009.

Supported in part by a Research to Prevent Blindness Challenge Grant, Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine (B.H.J.), and National Institutes of Health 1KL2 RR024990 Multidisciplinary Clinical Research Training Award (B.H.J.).

None of the authors have any financial interest in any of the material discussed in this article.

Reprints: Bennie H. Jeng, Department of Ophthalmology, University of California, San Francisco, 10 Koret Way, K-304 San Francisco, CA 94143 (e-mail:

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