ArticleIndian journal of ophthalmology2026
Comparison of smear positivity from anterior and posterior (endothelial) corneal scrapings obtained per-operatively in patients undergoing therapeutic penetrating keratoplasty - A retrospective study.
Article in Indian journal of ophthalmology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo compare the microbiological positivity of corneal smears obtained from the anterior corneal surface and the posterior (endothelial) surface of the excised corneal button in patients undergoing therapeutic penetrating keratoplasty (TPK).
methodsThis retrospective study included patients who underwent TPK between August 2019 and January 2025 at a tertiary care center. Demographic and clinical details were retrieved from hospital and eye bank records, while microbiological data were obtained from the microbiology department. Intraoperative corneal scrapings were collected from the anterior corneal surface prior to trephination and from the posterior (endothelial) surface of the excised recipient corneal button. Smears were examined using standard staining techniques. Patients with incomplete microbiological data or noninfective indications were excluded. Microbiological findings from anterior and posterior samples were compared using the Chi-square test, with P < 0.05 considered statistically significant.
resultsOf 252 TPKs performed, 132 patients met the inclusion criteria. Trauma was the most common predisposing factor (44.5%). Anterior corneal scrapings were positive in 26.5% (n = 35) of cases, with fungal elements predominating (74.3%), followed by Gram-positive cocci and Gram-negative organisms. Posterior (endothelial) scrapings showed a higher positivity rate of 34.8% (n = 46), with fungi accounting for 89.1% of positive samples. Both samples were negative in 51.5% of cases. Posterior scrapings demonstrated significantly higher positivity than anterior scrapings ( P = 0.046). Among cases positive in both samples (n = 17), 76.1% showed concordant organisms, while 23.9% were discordant.
conclusionPosterior corneal (endothelial) scraping yields higher microbiological positivity than conventional anterior scraping and serves as a valuable adjunct. Combining both techniques may enhance pathogen detection in advanced infectious keratitis.
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