Post-Keratoplasty Microbial Keratitis in the Era of Lamellar Transplants—A Comprehensive Review

TL;DR

This paper reviews how microbial keratitis differs in transplanted corneas, especially with lamellar transplants, and suggests updated management strategies.

Contribution

The paper introduces interface keratitis as a new form of microbial keratitis specific to lamellar transplants.

Findings

Post-transplant microbial keratitis has a distinct etiology due to immunosuppressive treatments and sutures.

Lamellar transplants have introduced interface keratitis, a new clinical entity.

Management strategies for microbial keratitis need to be updated for post-transplant patients.

Abstract

Microbial keratitis in a post-transplant cornea should be considered a distinct entity from microbial keratitis in a non-transplant cornea. Firstly, the use of immunosuppressive treatments and sutures in corneal transplants changes the etiology of keratitis. Secondly, corneal transplant has an impact on corneal biomechanics and structure, which facilitates the spread of infection. Finally, the emergence of lamellar transplants has introduced a new form of keratitis known as interface keratitis. Given these factors, there is a clear need to update our understanding of and management strategies for microbial keratitis following corneal transplantation, especially in the era of lamellar transplants. To address this, a comprehensive review is provided, covering the incidence, risk factors, causes, and timing of microbial keratitis, as well as both clinical and surgical management approaches for its treatment in cases of penetrating and lamellar corneal transplants.