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Infectious endophthalmitis after Boston type 1 keratoprosthesis implantation.
Cornea 2012; 31(4):346-9C

Abstract

PURPOSE

To determine the incidence, clinical features, and outcomes of infectious endophthalmitis after Boston Type 1 Keratoprosthesis (KPro) implantation.

METHODS

Retrospective, consecutive case series. Chart review of 105 patients (126 eyes) who had KPro implantation at Cincinnati Eye Institute between November 2004 and November 2010 and who were followed up for at least 1 month (range, 1 month to 66 months; mean 25 months) revealed 3 cases who developed infectious endophthalmitis.

RESULTS

One patient had a history of congenital glaucoma, and 2 patients had Stevens-Johnson syndrome. Two had KPro implantation for penetrating keratoplasty failure and 1 had necrosis of a previous KPro cornea. The incidence of endophthalmitis was 2.4%. All patients wore a contact lens and were on vancomycin and a fourth-generation fluoroquinolone (moxifloxacin). Vitreous fluid cultures yielded Ochrobactrum anthropi, Candida parapsilosis, and Candida albicans. All patients received intravitreal amphotericin, vancomycin, and/or ceftazidime. Topical and oral antiinfective agents were tailored based on sensitivities. One patient required KPro removal and therapeutic penetrating keratoplasty. Vision did not recover for 2 patients who presented with vision decreased to light perception. One patient, who presented with decreased vision of 20/400, recovered to 20/60.

CONCLUSIONS

Infectious endophthalmitis is a devastating complication that can occur after Boston KPro implantation even with prophylactic vancomycin, a fourth-generation fluoroquinolone, and a therapeutic contact lens. Fungal and gram-negative organisms are a growing cause for concern. Further study is needed on optimal prophylaxis regimens, including the use of antifungals, especially for high-risk eyes, such as those with autoimmune cicatrizing disease.

Authors+Show Affiliations

Cincinnati Eye Institute, Cincinnati, OH, USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22314825

Citation

Chan, Clara C., and Edward J. Holland. "Infectious Endophthalmitis After Boston Type 1 Keratoprosthesis Implantation." Cornea, vol. 31, no. 4, 2012, pp. 346-9.
Chan CC, Holland EJ. Infectious endophthalmitis after Boston type 1 keratoprosthesis implantation. Cornea. 2012;31(4):346-9.
Chan, C. C., & Holland, E. J. (2012). Infectious endophthalmitis after Boston type 1 keratoprosthesis implantation. Cornea, 31(4), pp. 346-9. doi:10.1097/ICO.0b013e31821eea2f.
Chan CC, Holland EJ. Infectious Endophthalmitis After Boston Type 1 Keratoprosthesis Implantation. Cornea. 2012;31(4):346-9. PubMed PMID: 22314825.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Infectious endophthalmitis after Boston type 1 keratoprosthesis implantation. AU - Chan,Clara C, AU - Holland,Edward J, PY - 2012/2/9/entrez PY - 2012/2/9/pubmed PY - 2012/7/17/medline SP - 346 EP - 9 JF - Cornea JO - Cornea VL - 31 IS - 4 N2 - PURPOSE: To determine the incidence, clinical features, and outcomes of infectious endophthalmitis after Boston Type 1 Keratoprosthesis (KPro) implantation. METHODS: Retrospective, consecutive case series. Chart review of 105 patients (126 eyes) who had KPro implantation at Cincinnati Eye Institute between November 2004 and November 2010 and who were followed up for at least 1 month (range, 1 month to 66 months; mean 25 months) revealed 3 cases who developed infectious endophthalmitis. RESULTS: One patient had a history of congenital glaucoma, and 2 patients had Stevens-Johnson syndrome. Two had KPro implantation for penetrating keratoplasty failure and 1 had necrosis of a previous KPro cornea. The incidence of endophthalmitis was 2.4%. All patients wore a contact lens and were on vancomycin and a fourth-generation fluoroquinolone (moxifloxacin). Vitreous fluid cultures yielded Ochrobactrum anthropi, Candida parapsilosis, and Candida albicans. All patients received intravitreal amphotericin, vancomycin, and/or ceftazidime. Topical and oral antiinfective agents were tailored based on sensitivities. One patient required KPro removal and therapeutic penetrating keratoplasty. Vision did not recover for 2 patients who presented with vision decreased to light perception. One patient, who presented with decreased vision of 20/400, recovered to 20/60. CONCLUSIONS: Infectious endophthalmitis is a devastating complication that can occur after Boston KPro implantation even with prophylactic vancomycin, a fourth-generation fluoroquinolone, and a therapeutic contact lens. Fungal and gram-negative organisms are a growing cause for concern. Further study is needed on optimal prophylaxis regimens, including the use of antifungals, especially for high-risk eyes, such as those with autoimmune cicatrizing disease. SN - 1536-4798 UR - https://www.unboundmedicine.com/medline/citation/22314825/Infectious_endophthalmitis_after_Boston_type_1_keratoprosthesis_implantation_ L2 - http://Insights.ovid.com/pubmed?pmid=22314825 DB - PRIME DP - Unbound Medicine ER -