Table 3

 Recipient data (postoperative)

Series No1st day, morning1st day, evening2nd day, morning2nd day, evening3rd day4th daySubsequent follow upAt healing
VA, visual acuity; GC, gentamicin; VM, vancomycin; KP, keratoprecipitates; AC, anterior chamber; PK, penetrating keratoplasty; poly B, polymyxin B.
1Uneventful, 4-5 suture abscess. Betadine, cleaning, routine medication GC-4 + VA, 3/60Intense pain, lid oedema, profuse mucopurulent discharge, more suture abscess. Cleaning, sample for microbiology, Betadine, cauteryWorsen, hazy cornea. Standard corneal ulcer therapyTotal graft melting. Therapeutic PK planned. Poly B drop 50 000 IU ½ hourly, neosporin ointment 3 times dailyTotal therapeutic PK (figs 3, 4). Intracameral VM Slough sent for microbiologyPseudomonas growth from graft ulcer specimen, sensitive to poly B. Resistant to all tested antibiotics .Standard therapy tapered poly B drop 50 000 IU ½ hourly Neosporin ointment 3 times dailyPseudomonas growth from infected button, sensitive to poly B. Resistant to all tested antibiotics. Therapy continued, gradual remission (fig 5)Visual acuity counting fingers close to face. Leucomatous corneal opacity
2Uneventful, 4–5 suture abscess. Betadine cleaning, routine medication GC-4 + VA-6/24PIntense pain, lid oedema, profuse mucopurulent discharge, 2 mm graft ulcer, hypopyon (fig 6) Cleaning, sample for microbiology, Betadine, cautery, standard corneal ulcer therapyTotal graft hazy, poly B drop 50 000 IU ½ hourly neosporin ointment 3 times daily addedGraft melting. Therapy continuedGraft removal, VM wash, slough for microbiology. Standard therapy tapered, poly B drop and neosporin ointment continuedPseudomonas growth from graft ulcer specimen, sensitive to poly B. Resistant to all tested antibiotics, poly B drop and neosporin ointment continuedGradual remissionVisual acuity 1/60. Leucomatous corneal opacity
3Intense pain, lid oedema, profuse mucopurulent discharge, multiple suture abscess. Cleaning, sample for microbiology, Betadine, cautery, routine post-keratoplasty therapyWorsen, hazy cornea, hypopyon + standard corneal ulcer therapy, poly B drop 50 000 IU ½ hourly, neosporin ointment 3 times dailyStatus quoStatus quo. Therapy continuedPartial keratectomy, Betadine cauteryPseudomonas growth from graft ulcer specimen, sensitive to poly B, Resistant to all tested antibiotics. Standard therapy tapered poly B drop Neosporin ointment continuedGradual remissionVisual acuity, defective PR. Leucomatous corneal opacity
4Intense pain, lid oedema, profuse mucopurulent discharge, suture abscess cleaning, sample for microbiology, Betadine cautery. Standard therapy for corneal ulcerWorsen, hazy cornea, hypopyon, poly B drop 50 000 IU ½ hourly, neosporin ointment 3 times dailyHypopyon reducedStatus quoGraft melting. PR inaccuratePseudomonas growth from graft ulcer specimen, sensitive to poly B. Resistant to all tested antibiotics. Standard therapy tapered poly B drop 50 000 IU ½ hourly. Neosporin ointment continuedGradual remissionVisual acuity hand movement close to face. Leucomatous corneal opacity
5Uneventful, 4–5 suture abscess. Betadine, cleaning, routine medication VA-6/12Intense pain, lid oedema, profuse mucopurulent discharge, more suture abscess. Cleaning, sample for microbiology, Betadine cauteryWorsen, hazy cornea. Standard corneal ulcer therapy poly B drop 50 000 IU ½ hourly Neosporin ointment 3 times dailyGraft removal, VM wash, slough for microbiology. Standard therapy tapered, poly B drop 50 000 IU ½ hourly, neosporin ointment 3 times dailyRemission of pain, lid oedema, dischargePseudomonas growth from graft ulcer specimen, sensitive to poly B. Resistant to all tested antibiotics. Standard therapy tapered poly B drop 50 000 IU ½ hourly Neosporin ointment 3 times dailyGradual remissionVisual acuity 6/9. Clear cornea
6Multiple suture abscess Betadine cleaning, routine medication GC-2+VA-1/60 KP ++cells in AC+Intense pain, lid oedema, profuse mucopurulent discharge, more suture abscess. Cleaning, sample for microbiology, Betadine cauteryWorsen, hazy cornea. Standard corneal ulcer therapy poly B drop 50 000 IU ½ hourly Neosporin ointment 3 times dailyKP + cells in AC occasionalPseudomonas growth from graft ulcer specimen, sensitive to poly B. Resistant to all tested antibiotics. Standard therapy tapered poly B drop 50 000 IU ½ hourly Neosporin ointment 3 times dailyGradual remissionVisual acuity 1/60. Leucomatous corneal opacity
7Multiple suture abscess. Betadine, cleaning, routine medication GC-2 + VA-1/60Intense pain, lid oedema, profuse mucopurulent discharge, more suture abscess. Cleaning, sample for microbiology, Betadine cauteryWorsen, hazy cornea. Standard corneal ulcer therapy poly B drop 50 000 IU½ hourly Neosporin ointment 3 times dailyGraft melting, therapeutic PKPseudomonas growth from graft ulcer specimen, sensitive to poly B. Resistant to all tested antibiotics. Standard therapy tapered poly B drop 50 000 IU ½ hourly Neosporin ointment 3 times dailyPseudomonas growth from infected button, sensitive to poly B. Resistant to all tested antibiotics. Therapy continued. Eye became phthisicalVisual acuity nil (phthisis bulbi)