Adjunctive tacrolimus in the treatment of fungal keratitis requiring therapeutic penetrating keratoplasty.

Objective: To determine the efficacy of adjunctive topical tacrolimus in improving graft survival and reducing post operative complications in patients with Therapeutic Penetrating Keratoplasty (TPK) for the treatment of fungal keratitis. Study design: Prospective consecutive series of 13 patients at Aravind Eye Hospital in Pondicherry, India with smear/culture positive fungal keratitis who require TPK. Main outcome measures: The primary outcome was graft clarity at 6 months. The secondary outcomes included BSCVA at 3 months and 6 months as well as intra-operative and post-operative complications. Results: A total of 13 patients with smear/culture positive fungal keratitis who underwent TPK were enrolled. The mean age of the patients was 62 years, with 77 % being male. Microbiological evidence of fungal infection was present in all patients. 9 out of 13 patients (69 %) were determined to either have a good outcome or be a good candidate for subsequent optical penetrating keratoplasty (PKP). BSCVA improved by 3.5 lines. Three patients had reinfection and required repeat TPK. There were no cases of endophthalmitis, and no patients required urgent glaucoma surgery. Conclusions: Adjunctive topical tacrolimus after therapeutic penetrating keratoplasty may reduce post operative complications and improve the chances of subsequent successful optical penetrating keratoplasty. Clinicaltrials gov identifier: NCT05110001.