Researchers found that infectious keratitis is a relatively common adverse event following ocular surface stem cell transplantation (OSST), even in successful cases, and aggressive medical/surgical therapy may be necessary.

A retrospective study evaluated 278 eyes that underwent OSST and assessed demographics, risk factors, courses, microbiological characteristics and outcomes. Of the participants, 33% had an epithelial defect, 69% required a bandage contact lens, 91% were on systemic immunosuppression and 25% had undergone ocular surgery within the last three months.

The team discovered that 52 eyes of 48 patients developed a combined 75 episodes of infectious keratitis: 44 bacterial keratitis, 24 fungal and seven herpes simplex virus. They note that gram-positive bacteria (79%) and Candida species (73%) were the most common bacterial and fungal pathogens. They add that the most common limbal stem cell deficiency etiologies included chemical/thermal (27 episodes), Stevens-Johnson syndrome (19), aniridia (8) and mucous membrane pemphigoid (8). While 75% of episodes resolved with antimicrobial treatment, 25% required a therapeutic keratoplasty.

The study concludes, “prophylactic topical antibiotics and a cicatrizing conjunctivitis diagnosis may account for the high proportion of fungal keratitis in this population.”

Cheung AY, Sarnicola E, Eslani M, et al. Infectious keratitis after ocular surface stem cell transplantation. Cornea. July 10, 2018. [Epub ahead of print].