Clinical Manifestations of Fungal Keratitis Following Penetrating Keratoplasty

Purpose: We evaluated the clinical manifestations and risk factors of fungal keratitis after penetrating keratoplasty (PKP). Methods: Eighteen patients who experienced fungal keratitis after PKP between January 2005 and January 2020 were included in this retrospective study. Clinical characteristics including sex, age, underlying disease, indication for PKP, symptom duration, visual acuity, graft state before infection, suture-related problems, size of epithelial defect, depth of infiltration, presence of hypopyon, use of eyedrops before infection, and the results of microbiological tests were analyzed. Patients were classified into the treatment success or failure group, and the risk factors were evaluated accordingly. Results: The mean age at diagnosis was 63.94 +/- 15.53 years. Fungal infection occurred a mean of 55.31 +/- 44.72 months after PKP. The mean symptom duration was 10.33 +/- 7.36 days. Of the 18 patients, 5 (27.8%) and 13 (72.2%) were in the treatment success and failure groups, respectively. Of the treatment failure group, seven patients (38.9%) underwent surgical management. The graft state before infection, symptom duration, and size of epithelial defects had significant correlations with treatment failure (all p < 0.05). Multivariate analysis identified graft state (p = 0.046) as a significant risk factor for treatment failure. Conclusions: Graft state before infection, symptom duration, and size of epithelial defects were associated with the prognosis of fungal keratitis after PKP. Graft state before infection was a significant risk factor for treatment failure.