{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T18:08:38Z","timestamp":1778609318302,"version":"3.51.4"},"reference-count":50,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2026,4,25]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Postoperative microbial keratitis (MK) can cause graft failure and vision loss following keratoplasty for corneal endothelial decompensation. Many previous studies found penetrating keratoplasty (PK) to result in a higher incidence of MK than Descemet\u2019s membrane endothelial keratoplasty (DMEK) or Descemet\u2019s stripping automated endothelial keratoplasty (DSAEK); however, findings vary. Recently, there has been a shift towards selective transplant procedures, with DMEK becoming mainstream over PK for endothelial decompensation globally around 2017. This systematic review therefore aims to determine the incidence of MK following DMEK, DSAEK and PK for endothelial decompensation from 2017 to 2025\u2009and to assess variation by follow-up duration, socioeconomic status, microbe type, patient age, contact lens wear and time after surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Multiple databases were systematically searched during 2017\u20132025. The Newcastle-Ottawa scale evaluated bias. Random-effects meta-analyses with logit transformation were performed; heterogeneity was assessed using the I\n                      <jats:sup>2<\/jats:sup>\n                      statistic. Sensitivity analyses confirmed robustness.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Pooled MK incidence was highest following PK (4.84%; 95%\u2009CI 3.25% to 7.15%; I\n                      <jats:sup>2<\/jats:sup>\n                      =97.7%), followed by DMEK (0.71%; 95%\u2009CI 0.18% to 2.86%; I\n                      <jats:sup>2<\/jats:sup>\n                      =83.5%), then DSAEK (0.27%; 95%\u2009CI 0.19% to 0.38%; I\n                      <jats:sup>2<\/jats:sup>\n                      =0%). Subgroup analyses showed variation but few significant differences. Trends suggested significantly higher MK incidence following PK in studies with longer follow-up. Bacterial keratitis was the most common overall; however, DMEK showed a more even distribution across microbe types.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MK incidence was highest following PK. High heterogeneity and limited DMEK\/DSAEK data warrant cautious interpretation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD420251179122.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2025-329293","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T17:20:24Z","timestamp":1778606424000},"page":"bjo-2025-329293","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Systematic review of the incidence of microbial keratitis following corneal transplantation for corneal endothelial decompensation"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4830-2725","authenticated-orcid":false,"given":"Millicent Christine","family":"Rayner","sequence":"first","affiliation":[{"name":"The University of Melbourne, Melbourne, Victoria, Australia"},{"name":"Surgical Research, Centre for Eye Research Australia Ltd, East Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gink","family":"Yang","sequence":"additional","affiliation":[{"name":"The University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9528-7005","authenticated-orcid":false,"given":"Mark","family":"Daniell","sequence":"additional","affiliation":[{"name":"Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"2026051210201609000_bjo-2025-329293v1.1","doi-asserted-by":"crossref","first-page":"e895","DOI":"10.1111\/aos.14404","article-title":"Microbial keratitis and clinical outcomes following penetrating and endothelial keratoplasty","volume":"98","author":"Dohse","year":"2020","journal-title":"Acta Ophthalmol"},{"key":"2026051210201609000_bjo-2025-329293v1.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.exer.2021.108495"},{"key":"2026051210201609000_bjo-2025-329293v1.3","article-title":"Corneal endothelial cell dysfunction: etiologies and management","volume":"10","author":"Feizi","year":"2018","journal-title":"Ther Adv Ophthalmol"},{"key":"2026051210201609000_bjo-2025-329293v1.4","doi-asserted-by":"crossref","DOI":"10.1155\/2022\/3091695","article-title":"Global Prevalence of Fuchs Endothelial Corneal Dystrophy (FECD) in Adult Population: A Systematic Review and Meta-Analysis","volume":"2022","author":"Aiello","year":"2022","journal-title":"J Ophthalmol"},{"key":"2026051210201609000_bjo-2025-329293v1.5","doi-asserted-by":"crossref","DOI":"10.3390\/jcm14072365","article-title":"Review of the Literature: Surgery Indications for Fuchs\u2019 Endothelial Corneal Dystrophy","volume":"14","author":"Tourabaly","year":"2025","journal-title":"J Clin Med"},{"key":"2026051210201609000_bjo-2025-329293v1.6","doi-asserted-by":"crossref","DOI":"10.1038\/s41536-025-00396-0","article-title":"Advancements in bioengineering for descemet membrane endothelial keratoplasty (DMEK)","volume":"10","author":"Zwingelberg","year":"2025","journal-title":"NPJ Regen Med"},{"key":"2026051210201609000_bjo-2025-329293v1.7","doi-asserted-by":"crossref","first-page":"413","DOI":"10.3390\/pathogens12030413","article-title":"Epidemiology and Economic Cost Analysis of Microbial Keratitis from a Tertiary Referral Hospital in Australia","volume":"12","author":"Daley","year":"2023","journal-title":"Pathogens"},{"key":"2026051210201609000_bjo-2025-329293v1.8","doi-asserted-by":"crossref","unstructured":"Song A , Deshmukh R , Lin H , et al . 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