**3. Clinical pearls on microbial complications after and before keratoplasty**

The most microbial reported associated with microbial keratitis which required keratoplasty are bacterial associations (Driebe and Stern 1983) following by mycotic and herpetic infections and less often, *Acanthamoeba sp*. The complications are more dangerous if there is an association with corneal stroma because the cornea needs respiration (Hill, 1976). Several factors contribute to adherence (Miller,1987) by bacteria: extracellular bacterial products such as alkaline proteases, protease IV, exotoxin A, exo-enzyme B and a recent small protease, called PASP (*P. aeruginosa* small protease) are been reported and contributes to epithelial erosions in keratitis caused by this agent. Recently, a group of molecules bacterial signaling, known as N-acilhomoserina lactones (AHLs), has also been reported as important factors in virulence of same bacterias (Marquart et al., 2005). The correlation between these factors of adherence and virulence, as the production of signals of molecular and expression of phenotypic characteristics including the production of enzymes, has studied by chromatography and bioassay in recent years. Moreover, the lack

For the analysis of the data, the following sources were consulted for this paper: Expert opinion, clinical case reports and specialized databases. In the first case, it was a survey with ophthalmologists skilled in corneal surgery, yielding six National specialists which are located geographically in Colombia. An unstructured interview was used for this. For the clinical reports, we reviewed the clinical cases of the service of ophthalmic consult of Fundación

Three bibliographic databases were searched: Medline, Ebsco, Hinary. To facilitate the search, the connector used was "and". In total 78 Articles were reviewed and 37 were

Keratoplasty,ophthalmology, ocular and immunology, keratoplasty and complications,

First, personal meeting with experts (ophthalmologist cornea specialists) was conducted for the review. Second, we reviewed clinical cases of the optometric clinical of Fundación Universitaria del Area Andina Seccional Pereira and private ophthalmologist consult. Additionally, the inclusion criteria respond to the search of articles and reports of work based on post keratoplasty infection, immunological and post-keratoplasty complications, astigmatism and post-keratoplasty using End Notes. The clinical cases selection was made by ophthalmological consult of control with complications post-keratoplasty. Three cases

Articles with the topic of ocular infections which did not require keratoplasty, and

**3. Clinical pearls on microbial complications after and before keratoplasty**  The most microbial reported associated with microbial keratitis which required keratoplasty are bacterial associations (Driebe and Stern 1983) following by mycotic and herpetic infections and less often, *Acanthamoeba sp*. The complications are more dangerous if there is an association with corneal stroma because the cornea needs respiration (Hill, 1976). Several factors contribute to adherence (Miller,1987) by bacteria: extracellular bacterial products such as alkaline proteases, protease IV, exotoxin A, exo-enzyme B and a recent small protease, called PASP (*P. aeruginosa* small protease) are been reported and contributes to epithelial erosions in keratitis caused by this agent. Recently, a group of molecules bacterial signaling, known as N-acilhomoserina lactones (AHLs), has also been reported as important factors in virulence of same bacterias (Marquart et al., 2005). The correlation between these factors of adherence and virulence, as the production of signals of molecular and expression of phenotypic characteristics including the production of enzymes, has studied by chromatography and bioassay in recent years. Moreover, the lack

immunological diseases without corneal compromises, were rejected.

Universitaria del Área Andina Seccional Pereira and the reports made by specialists.

**2. Statistical methods** 

**2.1 Method** 

**2.2 Databases** 

**2.3 Keywords** 

were included.

chosen for the report.

**2.4 Criteria for inclusion** 

**2.5 Criteria for exclusion** 

microbiological infections and cornea.

of tear that low lubrication caused by widespread use is a factor that should be taken into account users contact lenses (Kwong, 2007), because the tear is carrier lysozyme, lactoferrin, and immunoglobulins -lysine that being dehydrated lens facilitates molecular adhesion of *P. aeruginosa* (Zhu et al. 2002).
