SEARCHCOHORTophthalmology, cornea

cohort·ophthalmology, cornea, surgery, infectious disease, observational study·PMC10538606

Corneal Transplantation for Infectious Keratitis: A Prospective Dutch Registry Study

Cornea · 8 authors, 7 centres

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TL;DR

This prospective registry study analyzed 1111 corneal transplants for infectious keratitis in the Netherlands from 2007 to 2017, finding that graft survival was high for viral and bacterial causes but significantly worse for Acanthamoeba infections and for grafts larger than 8.5 mm.

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The study used data from the Netherlands Organ Transplant Registry to analyze all consecutive keratoplasties for infectious keratitis registered between 2007 and 2017. The primary outcome was graft survival, analyzed using Kaplan-Meier curves and Cox regression. The study compared the most common pathogens (viruses, bacteria, Acanthamoeba) and assessed factors like HLA matching, emergency procedures, and graft size. Central findings include that HLA matching did not provide a significant survival benefit, while emergency procedures and grafts larger than 8.5 mm were associated with worse outcomes. Graft survival was generally high for optical keratoplasty, but in therapeutic procedures, survival was significantly worse for Acanthamoeba compared to viral and bacterial infections.

STUDY TYPE

cohort

SPECIALTY

ophthalmology

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100% · A

ORIGINAL PAPER

PMC10538606

Corneal Transplantation for Infectious Keratitis: A Prospective Dutch Registry Study

Cornea

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ABSTRACT

Purpose: The aim of this study was to analyze real-world practice patterns and graft survival after corneal transplantation for infectious keratitis in the Netherlands. Methods: All consecutive keratoplasties for infectious keratitis registered in the Netherlands Organ Transplant Registry were included. Graft survival was analyzed using Kaplan–Meier survival curves with Cox regression to compare the 3 most common pathogens with subgroup analysis for type and reason of transplantation, sex, and graft size. Multivariable analysis was performed using the same explanatory factors. Results: Between 2007 and 2017, 1111 keratoplasties for infectious keratitis were registered in the Netherlands Organ Transplant Registry. The most common pathogens were viruses (n = 437), bacteria (n = 271), and Acanthamoeba (n = 121). Human leukocyte antigen (HLA) matching did not provide a significant survival benefit, whereas emergency procedures showed worse graft survival [hazard ratio (HR) = 0.40, P = 0.120; HR = 2.73, P < 0.001, respectively]. Graft size >8.5 mm was significantly worse than graft size 8.5 mm (HR = 2.062, P = 0.010). In therapeutic keratoplasty, graft survival was significantly worse for Acanthamoeba than viral keratitis (HR = 2.36, P = 0.008). In the multivariable model, adjusting for graft size, type, and reason for transplantation, viral and bacterial keratitis did not differ significantly in graft survival, and Acanthamoeba showed a significantly worse prognosis (vs. viral keratitis, HR = 2.30, P < 0.001; bacterial keratitis, HR = 2.65, P < 0.001). Conclusions: Viral keratitis was the most common indication for transplantation, followed by bacterial and Acanthamoeba keratitis. HLA matching did not offer protection over elective non-HLA–matched procedures, whereas emergency procedures and grafts sized >8.5 mm showed poor survival. In optical keratoplasty, survival is high for all pathogens, whereas in therapeutic keratoplasty Acanthamoeba shows poor outcome.

CITATION EXPORT

Judith M. J. Veugen, Suryan L. Dunker, Petra F. G. Wolffs et al.. Corneal Transplantation for Infectious Keratitis: A Prospective Dutch Registry Study. Cornea. (2023). https://doi.org/10.1097/ICO.0000000000003218

AUTHORS

8 · 7 CENTRES

Judith M. J. Veugen, Suryan L. Dunker, Petra F. G. Wolffs, Paul H. M. Savelkoul, Bjorn Winkens, Frank J. H. M. van den Biggelaar, Rudy M. M. A. Nuijts, Mor M. Dickman

*University Eye Clinic, Maastricht University Medical Center+, Maastricht, the Netherlands;
†School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands;
‡Department of Medical Microbiology, Maastricht University Medical Centre+, Nutrim School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands;
§Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands;
¶Department of Medical Microbiology and Infection Control, Amsterdam Infection and Immunity Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands;
║Department of Methodology and Statistics, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; and
**Department of Ophthalmology, Zuyderland Medical Center, Heerlen, the Netherlands.