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Microbial keratitis after Boston type I keratoprosthesis implantation: incidence, organisms, risk factors, and outcomes.
Ophthalmology 2013; 120(11):2209-16O

Abstract

PURPOSE

To identify the incidence of and risk factors for microbial keratitis after implantation of the Boston type I keratoprosthesis (Massachusetts Eye and Ear Infirmary, Boston, MA).

DESIGN

Retrospective, single-surgeon consecutive case series.

PARTICIPANTS

A total of 105 patients (125 keratoprosthesis procedures in 110 eyes) who underwent Boston type I keratoprosthesis implantation at the Jules Stein Eye Institute between May 1, 2004, and April 1, 2012.

METHODS

Data regarding ocular history, relevant intraoperative data, postoperative management, and outcomes were collected for each procedure. Risk factor analyses were performed using the Fisher exact test, log-rank test, and hazard ratio (HR).

MAIN OUTCOME MEASURES

Incidence of microbial keratitis, organisms responsible, risk factors, and outcomes.

RESULTS

During the period under review, 20 presumed infectious infiltrates were diagnosed in 15 eyes (13.6%) of 15 patients (14.3%), for a rate of 0.073 infections per eye-year. The rate of culture-positive bacterial keratitis was 0.022 infections per eye-year, and the rate of culture-positive fungal keratitis was 0.015 infections per eye-year. Topical vancomycin use, topical steroid use, and contact lens wear did not increase the incidence of infectious keratitis, but prolonged vancomycin use was associated with an increased risk for fungal keratitis and infectious keratitis overall. Persistent corneal epithelial defect formation also was associated with an increased incidence of fungal keratitis and infectious keratitis overall. There were no cases of endophthalmitis resulting from infectious keratitis.

CONCLUSIONS

Infectious keratitis develops in 13.6% of eyes after keratoprosthesis implantation, with a similar rate of culture-positive bacterial and fungal keratitis. The observed rate of microbial keratitis suggests the need for additional topical antimicrobial prophylaxis after keratoprosthesis implantation in eyes at higher risk, such as those with persistent corneal epithelial defect formation or prolonged vancomycin use.

Authors+Show Affiliations

Cornea Service, The Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, California.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23747162

Citation

Kim, Michelle J., et al. "Microbial Keratitis After Boston Type I Keratoprosthesis Implantation: Incidence, Organisms, Risk Factors, and Outcomes." Ophthalmology, vol. 120, no. 11, 2013, pp. 2209-16.
Kim MJ, Yu F, Aldave AJ. Microbial keratitis after Boston type I keratoprosthesis implantation: incidence, organisms, risk factors, and outcomes. Ophthalmology. 2013;120(11):2209-16.
Kim, M. J., Yu, F., & Aldave, A. J. (2013). Microbial keratitis after Boston type I keratoprosthesis implantation: incidence, organisms, risk factors, and outcomes. Ophthalmology, 120(11), pp. 2209-16. doi:10.1016/j.ophtha.2013.05.001.
Kim MJ, Yu F, Aldave AJ. Microbial Keratitis After Boston Type I Keratoprosthesis Implantation: Incidence, Organisms, Risk Factors, and Outcomes. Ophthalmology. 2013;120(11):2209-16. PubMed PMID: 23747162.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Microbial keratitis after Boston type I keratoprosthesis implantation: incidence, organisms, risk factors, and outcomes. AU - Kim,Michelle J, AU - Yu,Fei, AU - Aldave,Anthony J, Y1 - 2013/06/06/ PY - 2012/12/13/received PY - 2013/04/25/revised PY - 2013/05/01/accepted PY - 2013/6/11/entrez PY - 2013/6/12/pubmed PY - 2014/1/11/medline SP - 2209 EP - 16 JF - Ophthalmology JO - Ophthalmology VL - 120 IS - 11 N2 - PURPOSE: To identify the incidence of and risk factors for microbial keratitis after implantation of the Boston type I keratoprosthesis (Massachusetts Eye and Ear Infirmary, Boston, MA). DESIGN: Retrospective, single-surgeon consecutive case series. PARTICIPANTS: A total of 105 patients (125 keratoprosthesis procedures in 110 eyes) who underwent Boston type I keratoprosthesis implantation at the Jules Stein Eye Institute between May 1, 2004, and April 1, 2012. METHODS: Data regarding ocular history, relevant intraoperative data, postoperative management, and outcomes were collected for each procedure. Risk factor analyses were performed using the Fisher exact test, log-rank test, and hazard ratio (HR). MAIN OUTCOME MEASURES: Incidence of microbial keratitis, organisms responsible, risk factors, and outcomes. RESULTS: During the period under review, 20 presumed infectious infiltrates were diagnosed in 15 eyes (13.6%) of 15 patients (14.3%), for a rate of 0.073 infections per eye-year. The rate of culture-positive bacterial keratitis was 0.022 infections per eye-year, and the rate of culture-positive fungal keratitis was 0.015 infections per eye-year. Topical vancomycin use, topical steroid use, and contact lens wear did not increase the incidence of infectious keratitis, but prolonged vancomycin use was associated with an increased risk for fungal keratitis and infectious keratitis overall. Persistent corneal epithelial defect formation also was associated with an increased incidence of fungal keratitis and infectious keratitis overall. There were no cases of endophthalmitis resulting from infectious keratitis. CONCLUSIONS: Infectious keratitis develops in 13.6% of eyes after keratoprosthesis implantation, with a similar rate of culture-positive bacterial and fungal keratitis. The observed rate of microbial keratitis suggests the need for additional topical antimicrobial prophylaxis after keratoprosthesis implantation in eyes at higher risk, such as those with persistent corneal epithelial defect formation or prolonged vancomycin use. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/23747162/Microbial_keratitis_after_Boston_type_I_keratoprosthesis_implantation:_incidence_organisms_risk_factors_and_outcomes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(13)00410-7 DB - PRIME DP - Unbound Medicine ER -