Clinical Features of Microbial Keratitis Requiring PK Identified

PK with MK was linked with indications that suggest more severe infections, like more days to presentation and larger stromal infiltrates. Photo:  Aaron Bronner, OD. Click image to enlarge. In an abstract presented yesterday at ARVO 2025 in Salt Lake City, investigators highlighted their findings regarding the relationship microbial keratitis (MK) infection has with signs and symptoms. Since MK is preventable, understanding which features may be associated with infection progression to the point of needing penetrating keratoplasty (PK) will improve timely and targeted intervention, preserving vision as much as possible.The researchers, from the University of Michigan and UC San Francisco, specifically looked at the link between clinical features of MK and time to PK in a study called Automated Quantitative Ulcer Analysis (AQUA). Participants enrolled in the study were newly diagnosed with MK at academic centers in the US and India over a period spanning four years. In all, 511 patients were analyzed (165 US; 346 India). Individuals were followed for an average of 3.5 months; however, they were followed up to one year for PK.Of all participants, 12.3% ultimately underwent PK surgery. Using the Kaplan-Meier method, the researchers determined the time-dependent probability of PK was 1.3% at three months from presentation and 3.1% at 12 months. Increased hazard of penetrating keratoplasty was found to be linked with larger stromal infiltrate area, worse presenting best-corrected visual acuity, fungal keratitis and more days to presentation. The site of study (US vs. India) for patients was not found to be associated with PK hazard, however.Based on these distinct clinical associations, the authors of the study write that “clinicians may use these factors to inform patients affected with MK on hazard of PK.” Original abstract content ©2025 Association for Research in Vision and Ophthalmology. Sohail M, Lu MC, Niziol L, et al. Clinical features associated with penetrating keratoplasty in microbial keratitis—a multisite prospective cohort study. ARVO 2025 annual meeting.