Purpose. To analyse the clinical and microbiological characteristics and preexisting
ophthalmic and systemic conditions of infectious keratitis resulting in enucleation/evisceration
in a large tertiary referral center in a developed country (Hungary) over a period
of 12 years. Patients and Methods. A retrospective review of enucleated/eviscerated
eyes undergoing surgery between 2007 and 2018 at the Department of Ophthalmology of
Semmelweis University, Budapest, Hungary, with infectious keratitis as the primary
indication for enucleation or evisceration. For each subject, clinical history, B-scan
ultrasound report, and microbiological analyses were reviewed. Results. There were
48 enucleated/eviscerated eyes from 47 patients (29 females (61.7%), age at the time
of surgery 66.4 +/- 18.5 years). Indication for surgery was hopeless, unmanageable
keratitis (62.5%), and keratitis with endophthalmitis (37.5%). The most common preexisting
ophthalmic conditions were previous cataract surgery (60.4%), previous therapeutic
penetrating keratoplasty (PKP) (56.3%), corneal perforation (52.1%), glaucoma (41.7%),
and long-term topical steroid usage (31.3%). In order to treat keratitis, before enucleation
or evisceration, 20 eyes (41.7%) underwent PKP, 12 eyes (25.0%) amniotic membrane
transplantation, 8 eyes (16.7%) conjunctival autograft transplantation, 6 eyes (12.5%)
tarsorrhaphy, and 4 eyes (8.3%) vitrectomy to salvage the eye prior to the final treatment
of enucleation or evisceration. The most frequent preexisting systemic diseases were
hypertension (62.5%), cardiac disease (20.8%), diabetes mellitus (20.8%), and rheumatoid
arthritis (14.6%). Staphylococcus aureus (17.0%) and Propionibacterium acnes (12.8%)
were the most commonly isolated gram-positive bacteria, and Pseudomonas aeruginosa
was the most frequently isolated gram-negative pathogen bacterium (10.6%). Six globes
(12.5%) had positive fungal cultures (1 case of Candida albicans, Candida parapsilosis,
Trichosporon inkin, Acremonium sp., Fusarium sp., and Penicillium sp.). Conclusions.
Staphylococcus aureus, Propionibacterium acnes, and Pseudomonas aeruginosa keratitis
with or without endophthalmitis represent the most common indication for ocular enucleation/evisceration
in patients with microbial keratitis in a tertiary referral center in Hungary. The
incidence of enucleation and evisceration related to mycotic keratitis does not seem
to have increased within the last decade. Most frequent preexisting systemic diseases
in cases of enucleation and evisceration are hypertension, cardiac disease, diabetes
mellitus, and rheumatoid arthritis.
