Dr. Ashwani Kumar Ghai

Outcome of therapeutic keratoplasty in hopeless microbial keratitis cases otherwise advised evisceration

  • Authors Details :  
  • Rajat Jain,  
  • Neha Mohan,  
  • Ashwani Ghai,  
  • K C Gupta,  
  • Bhutia

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Purpose: To study the outcome of therapeutic keratoplasty in severe microbial keratitis cases otherwise advised evisceration. Methods: A retrospective, single-center clinical audit included 28 patients with severe microbial keratitis presenting from April 2014 to April 2016. Patients with microbial keratitis either affecting more than 2 quadrants of the limbus and/or cases with infections involving more than 180 mm2 of the cornea who were advised evisceration by more than one ophthalmologist were included. Cases with endophthalmitis were excluded. At 3 months, the outcome was “success” if resolution of infection occurred without recurrence and evisceration was not required. Success was termed “complete” if best vision was 6/24 or better and “partial” other- wise. The outcome was termed a “failure” if infection recurred in the graft or the eye was eviscerated. Results: Mean age of the patients (male:female, 17:11) was 49.5 years, and the mean duration of symptoms before surgery was 28.6 days. Evisceration was required in 2/28 cases. The outcome was “success” in 22/28 cases (78.6%)—complete (10/22); partial (12/22) —and “failure” in 6/28 cases. The outcome was poorer in general in fungal keratitis (n = 16) than bacterial keratitis (n = 7). Conclusions: Primary evisceration is best avoided in infections limited to the anterior segment. Even in hopeless cases, every eye deserves a fair chance.

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