Jp. Frangie et al., EFFICACY OF ROUTINE TOPICAL POSTOPERATIVE ANTIBIOTICS IN THE MANAGEMENT OF PENETRATING KERATOPLASTY, Annals of ophthalmology, 26(5), 1994, pp. 159-165
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.