Researchers found that infectious keratitis is a relatively common adverse event following ocular surface stem cell transplantation (OSST), even in successful cases, and aggressive medical/surgical therapy may be necessary.
A retrospective study evaluated 278 eyes that underwent OSST and assessed demographics, risk factors, courses, microbiological characteristics and outcomes. Of the participants, 33% had an epithelial defect, 69% required a bandage contact lens, 91% were on systemic immunosuppression and 25% had undergone ocular surgery within the last three months.
The team discovered that 52 eyes of 48 patients developed a combined 75 episodes of infectious keratitis: 44 bacterial keratitis, 24 fungal and seven herpes simplex virus. They note that gram-positive bacteria (79%) and Candida species (73%) were the most common bacterial and fungal pathogens. They add that the most common limbal stem cell deficiency etiologies included chemical/thermal (27 episodes), Stevens-Johnson syndrome (19), aniridia (8) and mucous membrane pemphigoid (8). While 75% of episodes resolved with antimicrobial treatment, 25% required a therapeutic keratoplasty.
The study concludes, “prophylactic topical antibiotics and a cicatrizing conjunctivitis diagnosis may account for the high proportion of fungal keratitis in this population.”
|Cheung AY, Sarnicola E, Eslani M, et al. Infectious keratitis after ocular surface stem cell transplantation. Cornea. July 10, 2018. [Epub ahead of print].|