Post penetrating keratoplasty infectious keratitis: Clinico-microbiological profile

Abstract Background: Post penetrating keratoplasty infectious keratitis (PPKIK) is a serious complication affecting graft clarity and visual prognosis. The microbiological diversity and risk factors vary across populations, particularly in tropical regions. Objectives: The objectives of the study were to determine the clinical profile, microbial spectrum, and treatment outcomes of PPKIK in a tertiary care setting. Materials and Methods: This prospective observational study was conducted at a tertiary eye care center over 12 months. A total of 136 patients who underwent penetrating keratoplasty were included. Clinical symptoms, risk factors, and visual acuity were documented. Corneal scrapings were subjected to Gram staining, KOH mount, and culture on appropriate media. ELISA was used for suspected viral cases. Treatment was initiated empirically and modified based on microbiological findings. Outcomes were evaluated at 6 months. Results: Out of 136 cases, 37 (27.2%) developed PPKIK. The most affected group was males aged 41–60 years (67.6%). Preoperative ocular surface disease (40.5%) and poor postoperative compliance (29.7%) were major risk factors. Bacterial infections were most common (37.8%), followed by fungal (24.3%) and mixed infections (16.2%). Visual improvement was noted in 81% of cases, with best outcomes in bacterial and viral infections. Surgical intervention was required in 18.9% of cases. Conclusion: PPKIK is significantly associated with modifiable pre- and postoperative factors. Early diagnosis, microbiological confirmation, and targeted therapy lead to better graft survival and visual outcomes.