EFFICACY OF ROUTINE TOPICAL POSTOPERATIVE ANTIBIOTICS IN THE MANAGEMENT OF PENETRATING KERATOPLASTY

Topical antibiotics are routinely used as prophylaxis in the postopera tive management of penetrating keratoplasty. There is a paucity of dat a to support the benefits of such therapy. Conversely, there is a grow ing body of knowledge that argues against unwarranted antibiotic use f or reasons that include recipient hypersensitivity reactions, epitheli al toxicity, and the threat of selecting resistant organisms. The auth ors retrospectively analyzed the immediate postoperative courses (thro ugh 6 postoperative weeks) of 439 consecutive penetrating keratoplasti es performed for various diagnoses. The incidence of serious bacterial complications between a historical control group (n = 275) managed wi th topical prophylactic antibiotics was compared with the complication rate of a study group (n = 164) in which routine prophylaxis was with held. All grafts were followed at day one, week one, and six weeks pos toperatively. The complications included stitch abscess, keratitis, an d frank ulceration. The control group had a complication rate of five of 275 (1.8%) compared with the rate of three of 164 (1.8%) in the stu dy group. The difference between the two groups was not statistically significant (by Fisher's two-tailed test). Our results indicate that t he incidence rate of serious bacterial complications in penetrating ke ratoplasty may not be affected by the use of prophylactic topical post operative antibiotics. These findings suggest the need for a prospecti ve study to investigate the benefits and possible risks of routine pro phylaxis after corneal transplantation.