Objective To study the clinical characteristics, pathogens, and treatment of graft fungal infection after corneal transplantation. Methods Twenty-nine patients (34 eyes) who were diagnosed with a graft fungal infection after keratoplasty in Qingdao Eye Hospital, Shandong Eye Institute, from October 2005 to January 2016, were reviewed. Twenty-five male (86%) and 4 female patients (14%) were included in the retrospective, interventional case series study. Data for primary diseases before keratoplasty, onset time of graft fungal infection, risk factors, clinical characteristics, pathogens, and treatments were analyzed. The data were analyzed with a signed-rank test. Results Penetrating keratoplasty was performed on 25 patients(74%) and lamellar keratoplasty was performed on 9 patients (26%). The most common primary disease before keratoplasty was infectious keratitis (24 cases, 70%). The average interval between keratoplasty and graft fungal infection was 39.5±43.0 months (1-144 months). The grafts were infected by fungi within 6 months in 9 cases (26%) and within 6 months to one year in 3 cases (9%) postoperatively. Fungal infection occurred during September-November in 17 cases (50%). Fungi were positively cultured in 27 cases (79%), and the main pathogens were fusarium (9 cases, 33%) and alternaria (6 cases, 22%). Infected lesions were located only on the corneal grafts in 29 cases (85%) and host corneas were involved in five cases (15%). Central or paracentral corneal ulcers were observed in 22 cases (65%), including large ulcers (length ＞4 mm) in 15 cases and small ulcers (length ≤4 mm) in 7 cases; and peripheral ulcers not bigger than 4 mm in length were seen in 12 cases. Twenty-seven cases selected drug therapy combined with surgical treatment, 4 cases chose simple drug therapy, and the other 3 cases (9%) declined surgeries and asked to be discharged from our hospital. The most common surgical scherne is keratoplasty (59%), followed by evisceration or enucleation (22%). Conclusion Infectious keratitis dominates the primary disease of corneal graft fungal infections, and most of them occurred in the autumn. Fusarium and alternaria are the main pathogens. Timely diagnosis and treatment can minimize the impact of graft fungal infections on patient vision.
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