Culture-Proven Endophthalmitis Associated With Penetrating Keratoplasty: Clinical Features, Microbiologic Aspects, and Outcomes.

PURPOSE: The objective of this study was to report the clinical features, microbiologic profile, treatments, and outcomes of culture-proven endophthalmitis following penetrating keratoplasty (PKP) in a contemporary cohort.

METHODS

A retrospective chart review of all patients with culture-proven endophthalmitis following PKP between January 2017 and July 2025 was conducted. Patients with endophthalmitis from endothelial keratoplasty, trauma, or other surgery were excluded.

RESULTS

Ten eyes of 10 patients met inclusion criteria. The mean age was 74 ± 3 years, and 70% were female. Indications for PKP were diverse, including 5 optical grafts for Fuchs dystrophy, keratoconus, and corneal edema and 4 therapeutic grafts. Initial visual acuity was hand motion on average. Hypopyon was present in 60%, vitritis in 80%, and suture abscesses in 30%. Initial management was intravitreal aspiration, with intravitreal injection of antimicrobials in 90% and primary pars plana vitrectomy in 10% of eyes. A pars plana vitrectomy for endophthalmitis was performed 1 to 5 days later in an additional 5 of 10 eyes (50%): 3 of 5 for debulking of the vitreous and 2 of 5 because of retinal detachments. Vitreous cultures were positive in all cases, with Candida in 40% isolates, Streptococcus sp. in 20%, Staphylococcus aureus in 10%, Staphylococcus epidermidis in 10%, Enterococcus in 10%, and Pseudomonas in 10%. Despite prompt treatment, visual acuity at the last follow-up was poor at <5/200; however, no eyes were eviscerated or enucleated.

CONCLUSIONS

Endophthalmitis after PKP is an uncommon but devastating complication. In this series, fungal pathogens accounted for a substantial proportion of cases. Management was individualized, but outcomes were generally poor.