Endophthalmitis Rates and Clinical Outcomes Following Penetrating and Endothelial Keratoplasty.

Abstract

PURPOSE\nTo evaluate endophthalmitis rates after penetrating keratoplasty (PK) and endothelial keratoplasty (EK) and to compare clinical outcomes.\n\n\nDESIGN\nRetrospective cohort study.\n\n\nMETHODS\nThe medical and billing records of several large academic private practices in Philadelphia, PA were electronically queried for all surgical visits during which a PK or EK was performed between April 1, 2012 and August 31, 2018. Demographic information and transplant characteristics were recorded for each patient and office visit. An additional query was performed to identify all cases of endophthalmitis based on diagnosis and procedure billing codes. Charts of patients with endophthalmitis were individually reviewed, and information was collected on triggering factors, clinical evaluation at presentation, management, culture data, visual outcomes, and graft survival rates. The main outcome measure was Incidence of presumed infectious endophthalmitis following PK or EK.\n\n\nRESULTS\nDuring the study period, 1,676 PKs and 2,292 EKs for 3,069 patients were performed. The mean age of patients in this transplant cohort was 66.4 (± 17.5) years and 54.6% of patients were female. Sixteen cases of endophthalmitis occurred during the study period; twelve cases of endophthalmitis occurred after PK and 4 cases occurred after EK. The rate of endophthalmitis after EK (4 of 2,292; 0.2%) was significantly lower than that after PK (12 of 1,676; 0.7%) (p = 0.01). Additionally, the odds of developing endophthalmitis after PK or EK performed in conjunction with anterior vitrectomy were significantly higher than after either PK or EK alone (OR: 8.66; 95% CI: 2.98-25.18; p < 0.001). Visual acuity outcomes were poorer after PK related endophthalmitis than EK associated cases (p = 0.01). The rate of graft failure at final follow-up was significantly higher in post-PK endophthalmitis (p = 0.02).\n\n\nCONCLUSIONS\nIn this large cohort of patients undergoing either PK or EK, rates of endophthalmitis were low for both procedures and significantly lower for EK compared to PK. Eyes with endophthalmitis after PK had poorer visual acuity outcomes and graft prognosis compared to those with endophthalmitis after EK.