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The following is a summary of “Outcomes of staged conjunctival flap and corneal transplantation for infectious keratitis resistant to medical treatment,” published in the December 2024 issue of Ophthalmology by Kilian et al. 

Researchers conducted a retrospective study to assess the outcomes of conjunctival flap (CF) followed by keratoplasty in patients with severe infectious keratitis (IK) unresponsive to medical treatment.    

They assessed 29 patients’ eyes with IK resistant to antibiotic treatment, related with stromal ulcer deepening to ≥50% of corneal thickness. All eyes underwent Gundersen’s CF procedure followed by either penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), or mushroom keratoplasty (MK), with a follow-up period of at least 4 months. Outcome measures were corrected distance visual acuity (CDVA), endothelial cell count (ECC), graft survival, and complications.   

The results showed IK healed in all eyes following CF surgery. The mean interval between CF and keratoplasty was 16.3±16.1 months, 55% of the patients that underwent PK, 35% MK, and 10% DALK. The mean follow-up duration was 39.6±34.3 months. At the last follow-up, CDVA ≥20/200 was achieved in 50% of PK, 70% of MK, and 33.3% of DALK. The annual endothelial cell loss was 24.5% after PK and 10.7% after MK. Graft failure occurred in 75% of PK, 20% of MK, and 100% of DALK. The most prevalent complications were endothelial decompensation without immunological rejection (34.5%, after 31.1±25.1 months) and graft rejection (17.2%, after 10.2±7.9 months, all in the PK group).    

Investigators concluded the CF surgery followed by staged keratoplasty was a potential alternative for severe IK cases, reducing the risk associated with immediate keratoplasty. 

Source: bjo.bmj.com/content/early/2024/12/06/bjo-2024-326225