Overview
Corneal graft infection refers to post-surgical infections affecting transplanted corneal tissue, potentially leading to graft rejection and loss of visual function. Prompt diagnosis and management are crucial to preserve graft survival and patient outcomes 15.Diagnosis
Clinical Presentation: Signs include graft edema, infiltrate, purulent discharge, and decreased visual acuity 15.
Diagnostic Tests: Slit-lamp examination, corneal scrapings for culture and sensitivity, and imaging studies (e.g., confocal microscopy) 1.
Grading: Classification systems like the International Council of Ophthalmology (ICO) grading for graft rejection can help assess severity 5.Management
First-Line Treatment: Topical fortified antibiotics (e.g., fortified fluoroquinolones or aminoglycosides) 15.
Adjunctive Therapies: Topical corticosteroids to reduce inflammation (e.g., prednisolone acetate 1%) 5.
Steroid-Sparing Agents: Consider cyclosporine A in high-risk cases to minimize steroid side effects 57.
Systemic Therapy: Oral or subconjunctival steroids for severe cases, especially with graft rejection 56.
Monitoring: Regular follow-ups including teleophthalmology approaches for timely intervention 1.Special Populations
Comorbidities: Vigilance in patients on bisphosphonate therapy due to potential uveitis and graft rejection 6.
Vaccination Considerations: Monitor for vaccine-associated graft rejection post-SARS-CoV-2 vaccination, particularly in older adults 2.Key Recommendations
Utilize real-time teleophthalmology for regular follow-ups to ensure timely detection and management of graft infections and rejections (Evidence: Moderate) 1.
Initiate treatment with fortified topical antibiotics for suspected corneal graft infections (Evidence: Moderate) 15.
Incorporate topical corticosteroids as first-line anti-inflammatory agents in graft rejection scenarios (Evidence: Strong) 5.
Consider cyclosporine A in high-risk patients to reduce reliance on systemic steroids (Evidence: Moderate) 57.
Exercise caution and monitor closely patients on bisphosphonate therapy for signs of graft rejection precipitated by uveitis (Evidence: Weak) 6.
Be alert to potential graft rejection following SARS-CoV-2 vaccination, especially in older patients (Evidence: Weak) 2.References
1 Siregar SR, Ardiani LS, Chua A, Chong BYQ, Tan DTH. Establishing a Virtual Corneal Clinic: A Real-Time Teleophthalmology Approach. Cornea 2023. link
2 Singh RB, Li J, Parmar UPS, Jeng BH, Jhanji V. Vaccine-associated corneal graft rejection following SARS-CoV-2 vaccination: a CDC-VAERS database analysis. The British journal of ophthalmology 2023. link
3 Savastano A, Rizzo S. A Novel Microsurgical Robot: Preliminary Feasibility Test in Ophthalmic Field. Translational vision science & technology 2022. link
4 Vasquez Perez A, Liu C. Human Ex Vivo Artificial Anterior Chamber Model for Practice DMEK Surgery. Cornea 2017. link
5 Kharod-Dholakia B, Randleman JB, Bromley JG, Stulting RD. Prevention and treatment of corneal graft rejection: current practice patterns of the Cornea Society (2011). Cornea 2015. link
6 Richards JC, Wiffen SJ. Corneal graft rejection precipitated by uveitis secondary to alendronate sodium therapy. Cornea 2006. link
7 Randleman JB, Stulting RD. Prevention and treatment of corneal graft rejection: current practice patterns (2004). Cornea 2006. link
8 Koay PY, Lee WH, Figueiredo FC. Opinions on risk factors and management of corneal graft rejection in the United kingdom. Cornea 2005. link