Background/Aims To explore the outcomes of conjunctival flap (CF) followed by keratoplasty in patients with severe infectious keratitis (IK) unresponsive to medical treatment. Methods This is a retrospective monocentric study including 29 eyes of 29 patients with IK resistant to antibiotic treatment associated with stromal ulcer deepening to ≥50% of corneal thickness. All eyes underwent Gundersen’s CF procedure and penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK) or mushroom keratoplasty (MK), at least 4 months thereafter. Outcome measures included corrected distance visual acuity (CDVA), endothelial cell count (ECC), graft survival and complications. Results IK healed in all eyes following CF. The mean time interval between CF and keratoplasty was 16.3±16.1 months. 55% of patients underwent PK, 35% MK and 10% DALK. Mean follow-up duration was 39.6±34.3 months. At the last available follow-up, a CDVA≥20/200 was obtained in 50%, 33.3% and 70% of cases, respectively after PK, DALK and MK. Mean annual endothelial cell loss was 24.5% following PK and 10.7% following MK. Overall, graft failure occurred in 75% of cases after PK, 100% after DALK and 20% after MK. The most frequent complications were endothelial decompensation without immunological rejection (34.5%, after 31.1±25.1 months) and graft rejection (17.2%, after 10.2±7.9 months, all in the PK group). Conclusion CF surgery followed by staged keratoplasty represents an alternative therapeutic approach to avoid high-risk keratoplasty ‘a chaud’ in cases of severe IK. Data are available upon reasonable request. Data are available on reasonable request.

中文翻译：

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分期结膜瓣和角膜移植治疗药物治疗耐药的感染性角膜炎的结局


背景/目的 探讨对药物治疗无反应的严重感染性角膜炎 （IK） 患者结膜瓣 （CF） 后进行角膜移植术的结果。方法 这是一项回顾性单中心研究，包括 29 名对抗生素治疗耐药的 IK 患者的 29 只眼睛，这些患者与基质溃疡加深至 ≥50% 的角膜厚度有关。此后至少 4 个月，所有眼睛都接受了 Gundersen 的 CF 手术和穿透性角膜移植术 （PK）、深前板层角膜移植术 （DALK） 或蘑菇角膜移植术 （MK）。结局指标包括矫正距离视力 （CDVA） 、内皮细胞计数 （ECC） 、移植物存活率和并发症。结果 CF 后所有眼睛的 IK 均愈合。CF 和角膜移植术的平均时间间隔为 16.3±16.1 个月。55% 的患者接受了 PK，35% 接受了 MK 和 10% DALK。平均随访时间为 39.6±34.3 个月。在最后一次可用的随访中，PK、DALK 和 MK 后分别在 50%、33.3% 和 70% 的病例中获得 CDVA≥20/200。PK 后平均年内皮细胞损失为 24.5%，MK 后为 10.7%。总体而言，PK 后 75% 的病例发生移植失败，DALK 后 100% 的病例发生移植物失败，MK 后 20% 的病例发生移植物失败。最常见的并发症是无免疫排斥反应的内皮失代偿 （34.5%，31.1±25.1 个月后） 和移植物排斥反应 （17.2%，10.2±7.9 个月后，均在 PK 组）。结论 CF 手术后进行分期角膜移植术代表了在严重 IK 病例中避免高危角膜移植术的另一种治疗方法。数据可根据合理要求提供。数据可应合理要求提供。