Infectious keratitis in patients undergoing Boston Type 1 keratoprosthesis (Boston KPro) procedure: case series

Nascimento, Heloísa; Oliveira, Lauro Augusto de; Höfling-Lima, Ana Luísa

doi:10.1590/s0004-27492011000200012

Cited by 6 publications

(2 citation statements)

References 5 publications

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“…17 Reports originating from developing countries were scarce and consisted mostly of case series from Brazil and India. 13–14, 20 Causative organisms included both yeasts ( Candida albicans, Candida parapsilosis, Candida glabrata, Candida famata ) and molds ( Fusarium spp., Aspergillus spp., Alternaria spp. ).…”

Section: Resultsmentioning

confidence: 99%

Fungal Infections After Boston Type 1 Keratoprosthesis Implantation

Odorcic

Haas

Gilmore

et al. 2015

Cornea

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Purpose To review the current literature describing cases of fungal keratitis and endophthalmitis following Boston Keratoprosthesis (KPro) implantation, and characterize the antifungal activity of 0.01% hypochlorous acid against medically relevant fungi. Methods A literature review of fungal keratitis or endophthalmitis in KPro patients from January 2001 to April 2015, and an in vitro time kill assay characterizing the fungicidal activity of 0.01% hypochlorous acid against fungi causing ocular infections. Results Fifteen publications, predominantly retrospective case series, were identified. Infection rates following KPro implantation ranged from 0.009–0.02 fungal infections per patient-year of follow-up. The largest single surgeon series reported an incidence of 2.4% for fungal endophthalmitis during a 10-year period. Causative organisms included both yeasts and molds. Outcomes were favorable if infections were caught early and treated appropriately; less favorable outcomes were reported in developing countries where fungal species are endemic and resources limited. 0.01% hypochlorous acid is rapidly fungicidal, reducing the number of viable yeast cells or mold conidia by at least 99.99% within 60 seconds. The antifungal activity extended to all molds (Acremonium kiliense, Aspergillus flavus, Aspergillus fumigatus, Fusarium solani, Mucor indicus) and yeast species (Candida albicans, Candida parapsilosis) tested. Conclusions Fungal infections remain a lifelong concern in patients following KPro implantation. There is a growing need for a standard antifungal prophylaxis regimen, especially in the developing world. The rapid broad-spectrum in vitro fungicidal activity of 0.01% hypochlorous acid against all fungi tested makes it an attractive candidate as an antifungal prophylaxis in KPro patients.

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Section: Resultsmentioning

confidence: 99%

Fungal Infections After Boston Type 1 Keratoprosthesis Implantation

Odorcic

Haas

Gilmore

et al. 2015

Cornea

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“…Polymers such as PMMA, poly(lactic- co -glycolic acid), and polyethylene are commonly used as substrates or scaffolds across many surgical specialties. The inert and hydrophobic properties of these materials, however, induce fibrous tissue envelopment and do not elicit any biological function within adjacent tissue, which is necessary for biointegration. , In KPros, poor biointegration can result in epithelial ingrowth, graft separation or cavitation, corneal melting, aqueous humor leakage, and intraocular infection, leading to implant failure and extrusion requiring further surgery and potentially compromising patient outcomes. − Despite these risks, KPro is the only management option where conventional keratoplasty has a high risk of failure, such as in diseases of the cornea with extensive limbal stem cell deficiency and vascularization, as seen following chemical burns. ,, …”

Section: Introductionmentioning

confidence: 99%

Nanohydroxyapatite Coating Attenuates Fibrotic and Immune Responses to Promote Keratoprosthesis Biointegration in Advanced Ocular Surface Disorders

Thirunavukarasu,

Morales-Wong,

Halim

et al. 2024

ACS Appl. Mater. Interfaces

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Keratoprosthesis (KPro) implantation is frequently the only recourse for patients with severe corneal disease. However, problems arise due to inadequate biointegration of the KPro, particularly the PMMA optical cylinder, such as tissue detachment, tissue melting, or eye-threatening infection in the interface. Here, using the AuroKPro as a model prosthesis, a surface functionalization approachcoating the optical cylinder with nanohydroxyapatite (nHAp)was trialed in rabbit eyes with and without a proceeding chemical injury. In chemically injured eyes, which simulated total limbal epithelial stem cell deficiency, clear benefits were conferred by the coating. The total modified Hackett–McDonald score and area of tissue apposition differences 12 weeks after implantation were 5.0 and 22.5%, respectively. Mechanical push-in tests revealed that 31.8% greater work was required to detach the tissues. These differences were less marked in uninjured eyes, which showed total score and tissue apposition differences of 2.5 and 11.5%, respectively, and a work difference of 23.5%. The improved biointegration could be contributed by the attenuated expression of fibronectin (p = 0.036), collagen 3A1 (p = 0.033), and α-smooth muscle actin (p = 0.045)proteins typically upregulated during nonadherent fibrous capsule envelopment of bioinert materialadjacent to the optical cylinders. The coating also appeared to induce a less immunogenic milieu in the ocular surface tissue, evidenced by the markedly lower expression of tear proteins associated with immune and stimulus responses. Collectively, the level of these tear proteins in eyes with coated prostheses was 1.1 ± 13.0% of naïve eyes: substantially lower than with noncoated KPros (246.5 ± 79.3% of naïve, p = 0.038). Together, our results indicated that nHAp coating may reduce the risk of prosthesis failure in severely injured eyes, which are representative of the cohort of KPro patients.

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Infections in Ocular Prosthesis

Miller

2016

Curr Ophthalmol Rep

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Infectious keratitis in patients undergoing Boston Type 1 keratoprosthesis (Boston KPro) procedure: case series

Cited by 6 publications

References 5 publications

Fungal Infections After Boston Type 1 Keratoprosthesis Implantation

Fungal Infections After Boston Type 1 Keratoprosthesis Implantation

Nanohydroxyapatite Coating Attenuates Fibrotic and Immune Responses to Promote Keratoprosthesis Biointegration in Advanced Ocular Surface Disorders

Infections in Ocular Prosthesis

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