Culture-Proven Endophthalmitis Associated With Penetrating Keratoplasty: Clinical Features, Microbiologic Aspects, and Outcomes

PURPOSE: The objective of this study was to report the clinical features, microbiologic profile, treatments, and outcomes of culture-proven endophthalmitis following penetrating keratoplasty (PKP) in a contemporary cohort. METHODS: A retrospective chart review of all patients with culture-proven endophthalmitis following PKP between January 2017 and July 2025 was conducted. Patients with endophthalmitis from endothelial keratoplasty, trauma, or other surgery were excluded. RESULTS: Ten eyes of 10 patients met inclusion criteria. The mean age was 74 ± 3 years, and 70% were female. Indications for PKP were diverse, including 5 optical grafts for Fuchs dystrophy, keratoconus, and corneal edema and 4 therapeutic grafts. Initial visual acuity was hand motion on average. Hypopyon was present in 60%, vitritis in 80%, and suture abscesses in 30%. Initial management was intravitreal aspiration, with intravitreal injection of antimicrobials in 90% and primary pars plana vitrectomy in 10% of eyes. A pars plana vitrectomy for endophthalmitis was performed 1 to 5 days later in an additional 5 of 10 eyes (50%): 3 of 5 for debulking of the vitreous and 2 of 5 because of retinal detachments. Vitreous cultures were positive in all cases, with Candida in 40% isolates, Streptococcus sp. in 20%, Staphylococcus aureus in 10%, Staphylococcus epidermidis in 10%, Enterococcus in 10%, and Pseudomonas in 10%. Despite prompt treatment, visual acuity at the last follow-up was poor at <5/200; however, no eyes were eviscerated or enucleated. CONCLUSIONS: Endophthalmitis after PKP is an uncommon but devastating complication. In this series, fungal pathogens accounted for a substantial proportion of cases. Management was individualized, but outcomes were generally poor.