{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:37:11Z","timestamp":1791221831559,"version":"4.1.0"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T00:00:00Z","timestamp":1693353600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec><jats:title>Background\/objectives<\/jats:title><jats:p>Post-keratoplasty infectious keratitis (PKIK) is a unique sight-threatening clinical entity which often poses significant therapeutic challenges. This study aimed to examine the clinical presentation, risk factors, management, and clinical outcomes of PKIK.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective study of all patients who presented to the Queen\u2019s Medical Centre, Nottingham, with PKIK between September 2015 and August 2022 (a 7-year period). Relevant data on types of keratoplasty, clinical presentations, causative microorganisms, management, and outcome were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty-nine PKIK cases, including four cases of interface infectious keratitis, were identified during the study period. The most common graft indications for PKP, DALK and EK were failed grafts (9, 37.5%), keratoconus (6, 54.5%) and Fuchs endothelial corneal dystrophy (FECD; 8, 57.1%), respectively. <jats:italic>Staphylococcus<\/jats:italic> spp. were the most commonly identified organisms (15, 50.0%). Bullous keratopathy (18, 36.7%), ocular surface disease (18, 36.7%), and broken\/loose sutures (15, 30.6%) were the most common risk factors. Concurrent use of topical steroids was identified in 25 (51.0%) cases. Of 31 functioning grafts at presentation, 12 (38.7%) grafts failed at final follow-up with 15 (48.4%) patients retaining a CDVA of \u22651.0 logMAR. The overall estimated 5-year survival rate post-PKIK was 55.9% (95% CI, 35.9%-75.9%), with DALK having the highest survival rate [63.6% (95% CI, 28.9%-98.3%)], followed by EK [57.1% (95% CI, 20.4%-93.8%)] and PKP [52.7% (95% CI, 25.1%-80.3%)], though no statistical difference was observed (p=0.48).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>PKIK represents an important cause of IK and graft failure. Bullous keratopathy, OSD and suture-related complications are the commonest risk factors, highlighting the potential benefit of prophylactic topical antibiotics (for unhealthy ocular surface) and early suture removal (where possible) in reducing the risk of PKIK. Graft survival may be higher in lamellar keratoplasty following PKIK but larger studies are required to elucidate this observation.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcimb.2023.1250599","type":"journal-article","created":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T06:44:59Z","timestamp":1693464299000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["A 7-year review of clinical characteristics, predisposing factors and outcomes of post-keratoplasty infectious keratitis: the Nottingham infectious keratitis study"],"prefix":"10.3389","volume":"13","author":[{"given":"Zun Zheng","family":"Ong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thai Ling","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lakshmi","family":"Suresh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmeen","family":"Hammoudeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Lister","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalia G.","family":"Said","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harminder S.","family":"Dua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren S. J.","family":"Ting","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,8,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e0119934","DOI":"10.1371\/journal.pone.0119934","article-title":"Graft rejection rate and graft failure rate of penetrating keratoplasty (PKP) vs lamellar procedures: a systematic review","volume":"10","author":"Akanda","year":"2015","journal-title":"PloS One"},{"key":"B2","doi-asserted-by":"publisher","first-page":"449","DOI":"10.3928\/1542-8877-19990601-07","article-title":"Microbial keratitis following penetrating keratoplasty","volume":"30","author":"Akova","year":"1999","journal-title":"Ophthalmic Surg. Lasers."},{"key":"B3","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1038\/sj.eye.6700617","article-title":"Immune defense at the ocular surface","volume":"17","author":"Akpek","year":"2003","journal-title":"Eye (Lond)."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e5864","DOI":"10.1097\/MD.0000000000005864","article-title":"Shifting trends in microbial keratitis following penetrating keratoplasty in Taiwan","volume":"96","author":"Chen","year":"2017","journal-title":"Medicine (Baltimore)."},{"key":"B5","doi-asserted-by":"publisher","first-page":"816","DOI":"10.1097\/00003226-200111000-00008","article-title":"Suture-related complications following keratoplasty: a 5-year retrospective study","volume":"20","author":"Christo","year":"2001","journal-title":"Cornea"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2652","DOI":"10.1177\/11206721211062979","article-title":"Post penetrating keratoplasty infectious keratitis: Clinico-microbiological profile and predictors of outcome","volume":"32","author":"Dave","year":"2022","journal-title":"Eur. J. Ophthalmol."},{"key":"B7","doi-asserted-by":"publisher","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":"B8","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.preteyeres.2018.04.003","article-title":"Neurotrophic keratopathy","volume":"66","author":"Dua","year":"2018","journal-title":"Prog. Retin Eye Res."},{"key":"B9","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1097\/ICO.0000000000000869","article-title":"Report of the eye bank association of america medical review subcommittee on adverse reactions reported from 2007 to 2014","volume":"35","author":"Edelstein","year":"2016","journal-title":"Cornea"},{"key":"B10","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1038\/sj.eye.6702953","article-title":"Characteristics of and risk factors for contact lens-related microbial keratitis in a tertiary referral hospital","volume":"23","author":"Edwards","year":"2009","journal-title":"Eye (Lond)."},{"key":"B11","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1136\/bjophthalmol-2018-312938","article-title":"Interface infectious keratitis after anterior and posterior lamellar keratoplasty. Clinical features and treatment strategies. A review","volume":"103","author":"Fontana","year":"2019","journal-title":"Br. J. Ophthalmol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.ajo.2019.01.022","article-title":"Deep anterior lamellar keratoplasty for keratoconus: multisurgeon results","volume":"201","author":"Gadhvi","year":"2019","journal-title":"Am. J. Ophthalmol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1001\/jamaophthalmol.2015.4776","article-title":"Global survey of corneal transplantation and eye banking","volume":"134","author":"Gain","year":"2016","journal-title":"JAMA Ophthalmol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1038\/sj.eye.6702546","article-title":"Postkeratoplasty emergency visits\u2013a review of 100 consecutive visits","volume":"21","author":"Gnanaraj","year":"2007","journal-title":"Eye (Lond)."},{"key":"B15","doi-asserted-by":"publisher","first-page":"3591","DOI":"10.2147\/OPTH.S275067","article-title":"Microbial keratitis in corneal transplants: A 12-year analysis","volume":"14","author":"Griffin","year":"2020","journal-title":"Clin. Ophthalmol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1016\/S0035-9203(00)90338-9","article-title":"Microbial keratitis\u2014a late complication of penetrating keratoplasty","volume":"94","author":"Huang","year":"2000","journal-title":"Trans. R. Soc. Trop. Med. Hygiene."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1080\/02713683.2019.1631852","article-title":"Microbial keratitis and ocular surface disease: A 5-year study of the microbiology, risk factors and clinical outcomes in sydney, Australia","volume":"44","author":"Khoo","year":"2019","journal-title":"Curr. Eye Res."},{"key":"B18","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1007\/s00417-008-0926-0","article-title":"Resolving the clinical acuity categories \"hand motion\" and \"counting fingers\" using the Freiburg Visual Acuity Test (FrACT)","volume":"247","author":"Lange","year":"2009","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1487","DOI":"10.1136\/bjophthalmol-2018-312709","article-title":"Fungal infection after endothelial keratoplasty: association with hypothermic corneal storage","volume":"103","author":"Lau","year":"2019","journal-title":"Br. J. Ophthalmol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"32751","DOI":"10.1038\/srep32751","article-title":"A comparative, retrospective, observational study of the clinical and microbiological profiles of post-penetrating keratoplasty keratitis","volume":"6","author":"Lin","year":"2016","journal-title":"Sci. Rep."},{"key":"B21","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/j.ajo.2011.01.038","article-title":"Microbial keratitis after penetrating keratoplasty: impact of sutures","volume":"152","author":"Moorthy","year":"2011","journal-title":"Am. J. Ophthalmol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1097\/ICO.0000000000000205","article-title":"Interface infection after descemet stripping automated endothelial keratoplasty: outcomes of therapeutic keratoplasty","volume":"33","author":"Nahum","year":"2014","journal-title":"Cornea"},{"key":"B23","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1038\/eye.2017.310","article-title":"Microbial keratitis in corneal grafts: predisposing factors and outcomes","volume":"32","author":"Okonkwo","year":"2018","journal-title":"Eye (Lond)."},{"key":"B24","doi-asserted-by":"publisher","first-page":"2432","DOI":"10.1016\/j.ophtha.2015.08.017","article-title":"Keratoplasty in the United States: A 10-year review from 2005 through 2014","volume":"122","author":"Park","year":"2015","journal-title":"Ophthalmology"},{"key":"B25","doi-asserted-by":"publisher","first-page":"536","DOI":"10.4103\/ijo.IJO_560_21","article-title":"Post-corneal transplant Candida keratitis - Incidence and outcome","volume":"70","author":"Sati","year":"2022","journal-title":"Indian J. Ophthalmol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1016\/j.survophthal.2020.11.001","article-title":"Infectious keratitis after lamellar keratoplasty","volume":"66","author":"Sharma","year":"2021","journal-title":"Surv Ophthalmol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1038\/s41433-019-0497-9","article-title":"Fuchs endothelial corneal dystrophy and corneal endothelial diseases: East meets West","volume":"34","author":"Soh","year":"2020","journal-title":"Eye (Lond)."},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.707242","article-title":"Post-keratoplasty infectious keratitis: epidemiology, risk factors, management, and outcomes","volume":"8","author":"Song","year":"2021","journal-title":"Front. Med. (Lausanne)."},{"key":"B29","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1016\/j.jtos.2021.08.007","article-title":"The epidemiology of infectious keratitis","volume":"28","author":"Stapleton","year":"2021","journal-title":"Ocul Surf"},{"key":"B30","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/j.ajo.2017.03.022","article-title":"Microbial keratitis after penetrating keratoplasty","volume":"178","author":"Sun","year":"2017","journal-title":"Am. J. Ophthalmol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"301","DOI":"10.3341\/kjo.2015.29.5.301","article-title":"Factors affecting treatment outcome of graft infection following penetrating keratoplasty","volume":"29","author":"Sung","year":"2015","journal-title":"Korean J. Ophthalmol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"e5","DOI":"10.1097\/ICL.0000000000000517","article-title":"Polymicrobial keratitis with cryptococcus curvatus, candida parapsilosis, and stenotrophomonas maltophilia after penetrating keratoplasty: a rare case report with literature review","volume":"45","author":"Ting","year":"2019","journal-title":"Eye Contact Lens."},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.715118","article-title":"Risk factors, clinical outcomes, and prognostic factors of bacterial keratitis: the nottingham infectious keratitis study","volume":"8","author":"Ting","year":"2021","journal-title":"Front. Med. (Lausanne)."},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.3389\/fdata.2023.1017420","article-title":"Big data in corneal diseases and cataract: Current applications and future directions","volume":"6","author":"Ting","year":"2023","journal-title":"Front. Big Data."},{"key":"B35","doi-asserted-by":"publisher","first-page":"966","DOI":"10.3390\/jof7110966","article-title":"Clinical characteristics and outcomes of fungal keratitis in the United Kingdom 2011-2020: A 10-year study","volume":"7","author":"Ting","year":"2021","journal-title":"J. Fungi (Basel)."},{"key":"B36","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.jtos.2021.11.003","article-title":"Diagnostic armamentarium of infectious keratitis: A comprehensive review","volume":"23","author":"Ting","year":"2022","journal-title":"Ocul Surf."},{"key":"B37","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1136\/bjophthalmol-2020-316128","article-title":"12-year analysis of incidence, microbiological profiles and in vitro antimicrobial susceptibility of infectious keratitis: the Nottingham Infectious Keratitis Study","volume":"105","author":"Ting","year":"2021","journal-title":"Br. J. Ophthalmol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"2543","DOI":"10.1038\/s41433-020-01272-5","article-title":"Seasonal patterns of incidence, demographic factors and microbiological profiles of infectious keratitis: the Nottingham Infectious Keratitis Study","volume":"35","author":"Ting","year":"2021","journal-title":"Eye (Lond)."},{"key":"B39","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.1038\/s41433-020-01339-3","article-title":"Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance","volume":"35","author":"Ting","year":"2021","journal-title":"Eye (Lond)."},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.835843","article-title":"Host defense peptides at the ocular surface: roles in health and major diseases, and therapeutic potentials","volume":"9","author":"Ting","year":"2022","journal-title":"Front. Med. (Lausanne)."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1201","DOI":"10.1001\/jamaophthalmol.2019.2745","article-title":"Interface haze after descemet stripping automated endothelial keratoplasty","volume":"137","author":"Ting","year":"2019","journal-title":"JAMA Ophthalmol."},{"key":"B42","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1136\/bjophthalmol-2011-300244","article-title":"Changing trends in keratoplasty in the West of Scotland: a 10-year review","volume":"96","author":"Ting","year":"2012","journal-title":"Br. J. Ophthalmol."},{"key":"B43","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1097\/00003226-199511000-00011","article-title":"Late microbial keratitis after corneal transplantation","volume":"14","author":"Tseng","year":"1995","journal-title":"Cornea"},{"key":"B44","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1016\/j.survophthal.2018.12.003","article-title":"The persistent dilemma of microbial keratitis: Global burden, diagnosis, and antimicrobial resistance","volume":"64","author":"Ung","year":"2019","journal-title":"Surv. Ophthalmol."},{"key":"B45","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1136\/bjo.86.3.261","article-title":"Risk factors for graft infection in India: a case-control study","volume":"86","author":"Vajpayee","year":"2002","journal-title":"Br. J. Ophthalmol."},{"key":"B46","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1016\/j.ophtha.2006.10.015","article-title":"Bacterial keratitis after penetrating keratoplasty: incidence, microbiological profile, graft survival, and visual outcome","volume":"114","author":"Wagoner","year":"2007","journal-title":"Ophthalmol."},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1038\/s41433-023-02573-1","article-title":"False positive microbiological results in Acanthamoeba keratitis: the importance of clinico-microbiological correlation","author":"Wong","year":"2023","journal-title":"Eye (Lond)"}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2023.1250599\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T06:45:01Z","timestamp":1693464301000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2023.1250599\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,30]]},"references-count":47,"alternative-id":["10.3389\/fcimb.2023.1250599"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2023.1250599","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,30]]},"article-number":"1250599"}}