Recurrent fungal keratitis after corneal transplantation is a primarily cause of treatment failure. Owing to different recurrence positions and clinical features, to choose the appropriate therapy is relative difficult.

This study was to investigate the clinical features, therapy and treating outcome of recurrent fungal keratitis after corneal transplantation.

Forty-one patients with recurrent fungal keratitis from 628 patients with fungal keratitis who underwent corneal transplantation at the Shandong Eye Hospital from January 2004 through December 2011 were retrospectively reviewed. The positions of recurrent lesions, managements and outcomes were analyzed.

The positions of recurrent keratitis included transplantation bed, anterior chamber and vitreous in the 41 patients. The fungal infection relapsed in 28 patients (7.12%) undergone penetrating keratoplasty (PKP) and 13 patients (5.53%) undergone lamellar keratoplasty (LKP), without significant difference between them (χ²=0.61, P>0.05). Thirty-six patients were cured, with the overall cure rate 87.80%. Among the 11 recurrence cases on the edge of recipient bed, 3 patients were cured by drug therapy, and other 8 patients were cured by surgery, including lesion resection and/or conjunctival flap cover for 6 patients with lesion >2 mm and secondary PKP for 2 patients with lesion≤2 mm. Four patients with recurrence lesion under the graft following LKP were treated by the reoperation PKP. The different managements were performed in 5 recurrent patients in anterior chamber, including intrachamber injection of drug for 2 patients, anterior chamber lavage for 2 patients and PKP again in 1 patient. Multiple-site recurrent lesions were seen in 12 patients, and the lesions were cured by drug therapy, lesion resection or conjunctival flap cover in 5 patients and by PKP again in 7 patients. In 9 patients with vitreous recurrence, only 4 patients were cured by anti-fungal drug, and ocular evisceration were performed in other 5 patients.

The clinical features and locations of recurrent fungal keratitis are key basis for the delection of therapeutic regimens. Based on different clinical features, most of the fungal keratitis recurrence after corneal transplantion can be cured. Drug therapy is preferred for the recurrence lesion on recipient bed, and intrachamber drug injection is preferred for recurrence in anterior chamber. For the patients with vitreous recurrence, vitrectomy combined with intravitreal drug should be performed as early as possible.

Cornea; Infection/recurrent, therapy;  Fungus; Keratoplasty; Retrospective