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Clinical Outcomes of Corneal Graft Infections Caused by Multi–Drug Resistant Pseudomonas Aeruginosa

Jain, Rajat MS; Murthy, Somasheila I. MS; Motukupally, Swapna Reddy MD

doi: 10.1097/ICO.0000000000000011
Clinical Science

Purpose: The aim was to assess the clinical outcomes of corneal graft infections caused by multi–drug resistant Pseudomonas aeruginosa (MDR-PA).

Methods: This is a retrospective case series of 38 patients with corneal graft infections caused by MDR-PA managed from June to December 2011. Clinical and demographic details, treatment outcome on primary therapy, cases requiring a repeat graft, their outcome, and recurrence rate on treatment were analyzed. The outcome measure was resolution of infection. Success was “complete” if resolution was seen without subsequent recurrence up to 2 weeks and “partial” if it required intervention such as cyanoacrylate glue application. It was a “failure” if the infection could not be controlled and the patient required a repeat graft or the eye had to be eviscerated.

Results: Thirty-one patients were initially treated with topical cefazolin 5% and ciprofloxacin 0.3%, 6 with topical colistin 0.19%, and 1 was treated with topical imipenem 1%. On this treatment, 9 cases showed complete success and 6 showed partial success. Twenty-two patients required a repeat graft, and 1 eye was eviscerated. The patients with outcome of success had smaller graft infiltrates (median area = 2 mm2; range = 1–24.6 mm2 vs. median infiltrate area = 24.8 mm2; range = 1.5–64 mm2) than those with an outcome of failure (P = 0.02). At the mean follow-up of 50 days, recurrence after the repeat surgery was seen in 4/22 (18.2%) patients.

Conclusions: Medical therapy can be tried in sensitive and smaller MDR-PA graft infiltrates, but larger infiltrates and those with endophthalmitis require early surgical intervention.

*Cornea and Anterior Segment Service, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India; and

Jhaveri Microbiology Services, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India.

Reprints: Somasheila I. Murthy, Head, Corneal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Banjara Hills, Rd No 2, Hyderabad 500034, Andhra Pradesh, India (e-mail:

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

R. Jain performed the literature review, analyzed the data, and wrote the manuscript. R. Jain, S. Reddy, and S. Murthy were responsible for the study conception and design. S. Murthy and S. Reddy revised the article critically for important intellectual content. All the authors included in this article fulfill the criteria of authorship. On behalf of all the coauthors, Rajat Jain, MS, states that he had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Ethics approval: Ethics committee/institutional review board approval was obtained.

Received July 23, 2013

Accepted September 16, 2013

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.