Clinical Outcomes of Corneal Graft Infections Caused by Multi–Drug Resistant Pseudomonas Aeruginosa

PURPOSE: The aim was to assess the clinical outcomes of corneal graft infections caused by multi-drug resistant Pseudomonas aeruginosa (MDR-PA). METHODS: This is a retrospective case series of 38 patients with corneal graft infections caused by MDR-PA managed from June to December 2011. Clinical and demographic details, treatment outcome on primary therapy, cases requiring a repeat graft, their outcome, and recurrence rate on treatment were analyzed. The outcome measure was resolution of infection. Success was "complete" if resolution was seen without subsequent recurrence up to 2 weeks and "partial" if it required intervention such as cyanoacrylate glue application. It was a "failure" if the infection could not be controlled and the patient required a repeat graft or the eye had to be eviscerated. RESULTS: Thirty-one patients were initially treated with topical cefazolin 5% and ciprofloxacin 0.3%, 6 with topical colistin 0.19%, and 1 was treated with topical imipenem 1%. On this treatment, 9 cases showed complete success and 6 showed partial success. Twenty-two patients required a repeat graft, and 1 eye was eviscerated. The patients with outcome of success had smaller graft infiltrates (median area = 2 mm; range = 1-24.6 mm vs. median infiltrate area = 24.8 mm; range = 1.5-64 mm) than those with an outcome of failure (P = 0.02). At the mean follow-up of 50 days, recurrence after the repeat surgery was seen in 4/22 (18.2%) patients. CONCLUSIONS: Medical therapy can be tried in sensitive and smaller MDR-PA graft infiltrates, but larger infiltrates and those with endophthalmitis require early surgical intervention.