Microbial keratitis--a late complication of penetrating keratoplasty.

A retrospective review of 323 penetrating keratoplasties performed in Taiwan between January 1993 and December 1997 revealed that late microbial keratitis developed in 39 eyes of 36 patients (12.1%). All patients were operated on by the same surgeon, and all were followed for at least 1 year. The mean interval between the corneal transplantation and the onset of graft infection was 8.6 +/- 8.8 months (range 3 weeks-47 months). Predisposing risk factors for keratitis included chronic blepharitis with poor lid hygiene (43.6%), suture-related problems (38.5%), dry eyes (28.2%), epithelial defects (25.6%), and use of contact lenses (5.1%). Infectious keratitis was diagnosed within 6 months after keratoplasty in 59% of cases. Positive cultures were obtained in 100% of the ulcers; Pseudomonas aeruginosa and Staphylococcus aureus were the most common pathogens. In the final visual outcome assessment, 30.8% of cases had clear grafts, 20.5% had graft failures, and 10.3% had corneal perforations.