Ocular Microbiology and Immunology Group
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2024 OMIG Abstract

Long-Term Graft Survival after Rose Bengal Photodynamic Antimicrobial Therapy for Infectious Keratitis and Keratoplasty

Jordan J. Huang¹, Paula A. Sepulveda-Beltran¹, Salomon Merikansky^1,2, Heather Durkee²,
Juan Carlos Navia^1,2, Brandon G. Chou^1,2, Alejandro Arboleda², Mariela C. Aguilar², Andrea Naranjo²,
Alex Gonzalez², Diego Altamirano¹, Carolina Mercado¹, Jana Tothova^1,2, Anat Galor^1,3, Harry W. Flynn, Jr¹, Jaime D. Martinez^1,2, Darlene Miller⁴, Carol L. Karp¹, Jean-Marie Parel^1,2, Guillermo Amescua<sup>1,2

1</sup>Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami FL; ²Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami FL; ³Surgical and Research Services, Miami Veterans Administration Medical Center, Miami, FL; ⁴Ocular Microbiology Laboratory, Department of Ophthalmology, Bascom Palmer Eye Institute,
University of Miami Miller School of Medicine, Miami FL; ⁵Florida Lions Ocular Pathology Laboratory, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami FL

Purpose: To evaluate the long-term graft survival outcomes for patients undergoing a therapeutic penetrating keratoplasty (TPK), optical penetrating keratoplasty (OPK), and deep anterior lamellar keratoplasty (DALK) following adjunct treatment with Rose Bengal Photodynamic Antimicrobial Therapy (RB-PDAT) for severe, progressive, infectious keratitis.

Methods: A retrospective chart review was performed for patients with infectious keratitis recalcitrant to standard medical treatment who underwent RB-PDAT followed by surgical intervention (TPK/OPK/DALK) at the Bascom Palmer Eye Institute from June 2016 to April 2024. The primary outcome was graft survival following treatment with RB-PDAT, which was evaluated using Kaplan-Meier curves with log ranks to compare the probability of graft survival between graft types. Corneal transplant outcomes were categorized as follows: successful transplant was defined as a clear cornea lacking signs of infection or rejection on last follow-up exam, transplant failure was defined as a cornea showing any signs of rejection (e.g. sub-epithelial opacities, anterior ciliary injection, edema, keratic precipitates or anterior chamber flare and cells), and recurrence was defined as positive post-surgical culture of the original pathogen following surgical intervention.

Results: A total of 55 eyes of 55 patients underwent surgical intervention following RB-PDAT. Specifically, 23 patients underwent an emergent TPK, 19 patients underwent an OPK, and 13 patients underwent a DALK. Mean follow-up times for TPK and OPK/DALK groups were 30.5±22.8 months and 40.7±25.7 months, respectively. Successful transplant was achieved in 72.7% (n = 40/55) of patients, transplant failure occurred in 25.5% (n = 14/55) of patients, and recurrence occurred in 1.8% (n = 1/55) of patients over an overall follow-up time of 31.8±23.8 months. Using Kaplan-Meier estimate curves, the overall probability of graft survival (n=55) at 1 and 2 years post-operatively was 86.2% (n=55) and 74.5% (n=55), respectively. Stratifying by type of corneal graft, the probability of survival for OPK/DALK was considerably higher than that of TPK, with a statistically significant result (p=0.01). TPK graft survival rates declined over time, from 85.0% at 1-year, 57.4% at 2- years, and 38% at 5- years post-operative follow-up. In contrast, OPK/DALK grafts maintained a higher survival rate of 89.3% throughout the 1-, 2-, and 5-years follow-up.

Conclusions: The current study indicates that patients treated with OPK/DALK following RB-PDAT had better long-term probability of graft survival at 1-, 2-, and 5-years post-operatively compared to patients who underwent a TPK.

Disclosure:

N (JJH, PAS-B, SM, JCN, BGC, AN, DA, CM, JT, AG, HWF, JDM, CLK); P (HD, AA, MCA, AG, DM, J-MP, GA)