Microbial Keratitis and Endophthalmitis After the Boston Type 1 Keratoprosthesis

Abstract

Postoperative infections are a serious issue that compromises device retention and visual outcomes after keratoprosthesis implantation.

Boston Type 1 Keratoprosthesis

“…Daily doxycycline (100 mg) was initiated and continued indefinitely for its anticollagenolytic effect. 16 Topically, 1% prednisolone acetate and 1% medroxyprogesterone were used concomitantly to provide the superior antiinflammatory efficacy of the former and the stronger anticollagenolytic activity of the latter. 16 They were administered 4 times a day for 3 months, 3 times a day for 3 months, 2 times a day for 3 months, and then once a day thereafter.…”

“…16 Topically, 1% prednisolone acetate and 1% medroxyprogesterone were used concomitantly to provide the superior antiinflammatory efficacy of the former and the stronger anticollagenolytic activity of the latter. 16 They were administered 4 times a day for 3 months, 3 times a day for 3 months, 2 times a day for 3 months, and then once a day thereafter. From January 1, 2008, until February 2011, every eye underwent a standard antimicrobial prophylactic regimen that involved the administration of topical vancomycin (16 or 25 mg/mL) and a fourth-generation fluoroquinolone antibiotic (either 0.3% gatifloxacin or 0.5% moxifloxacin).…”

“…These were administered 4 times a day for 3 months, 3 times a day for 3 months, 2 times a day for 3 months, and then once a day thereafter. In response to historical reports 17 and personal experience with an increased risk of fungal keratitis and endophthalmitis in this patient population, 16 a fornix rinse with 5% povidoneiodine solution was introduced in February 2011, at the time of the quarterly contact lens cleaning or replacement. After no appreciable decline in the incidence of fungal infections was observed, 16 a 7-day course of topical amphotericin B (1.5 mg/ mL) was introduced in February 2012 and administered 4 times daily after the completion of each quarterly povidoneiodine rinse.…”

“…The management of ulcerative keratitis, sterile vitritis, and endophthalmitis has been previously described. 16 Maculopathy included the new onset of epiretinal membranes, macular edema, and macular degeneration and the worsening of existing cases. Progressive optic neuropathy included cases involving progressive optic nerve cupping and/or atrophy associated with the loss of central visual acuity that was out of proportion to other contributing anatomic factors.…”

“…[10][11][12][13] The procedure is usually associated with rapid and maximum visual rehabilitation in the early postoperative course. 14 Unfortunately, this visual benefit may be compromised by ocular surface-related issues that contribute to the development of ulcerative keratitis [15][16][17] and/or endophthalmitis, [15][16][17][18][19] and the resultant potential for device extrusion. [2][3][4][5][6][7][8] In addition, other sight-threatening complications, such as retroprosthetic membranes, 20 maculopathy, 21 sterile vitritis, 22 retinal detachment, 21 and progressive optic neuropathy 23 may compromise an initially gratifying visual outcome.…”