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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.

*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

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