Successful Prevention of Bacterial Endophthalmitis in Eyes with the Boston Keratoprosthesis

Durand, Marlene L.; Dohlman, Claes H.

doi:10.1097/ico.0b013e3181983982

Cited by 139 publications

(141 citation statements)

References 9 publications

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“…Both are now relatively rare complications, 5,7,10 the former due to the advent of prophylactic antibiotics used indefinitely after implantation. 18 This study has several limitations. No attempts were made by the authors to correlate the adequacy of systemic immunosuppressant therapy with the incidence of RD outcomes in patients with systemic autoimmune disease.…”

Section: Other Factors Associated With Rdmentioning

confidence: 92%

Retinal detachments after Boston Keratoprosthesis: incidence, predisposing factors, and visual outcomes

et al. 2015

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Purpose-To determine the rates, predisposing factors, and visual outcomes of retinal detachment (RD) after Boston Keratoprosthesis (KPro) implantation.Methods-In this noncomparative, interventional case series, the medical records of 170 patients (205 eyes) who underwent Boston type 1 and type 2 KPro implantation at the Massachusetts Eye and Ear Infirmary between April 1993 and June 2009 were retrospectively reviewed. Incidence and annual rates of RD were calculated, and the roles of possible predictive factors for RD after KPro were investigated. Main outcome measures were rates of and risk factors for RD, visual acuity after RD, and surgical outcomes after repair.

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Section: Other Factors Associated With Rdmentioning

confidence: 92%

Retinal detachments after Boston Keratoprosthesis: incidence, predisposing factors, and visual outcomes

et al. 2015

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“…The recommended prophy laxis routine includes the use of daily topical fluoroquinolone drops, with a recent addition of topical 1.4% vancomycin, especially in cases of autoimmune diseases (2) . The inclusion of topical vancomycin to the standard prophylactic regimen has dramatically reduced the incidence of bacterial endophthalmitis in BKPro eyes (24) . The continued use of bandage contact lenses and the longterm use of broadspectrum antibiotics and corticosteroids, however, have the potential of altering the ocular microbiota and predispose fun gal colonization.…”

Section: Postoperative Management and Complicationsmentioning

confidence: 99%

“…Many of the serious complications are frequently seen in the first year of surgery. The greatest visionthreatening risk facing patients with any type of keratoprosthesis is bacterial endophthalmitis, most cases associated with Grampositive pathogens (2,24,27) . Early recogni tion and aggressive treatment are crucial for favorable results in the ses cases (28) .…”

Section: Postoperative Management and Complicationsmentioning

confidence: 99%

Boston type I keratoprosthesis: Review

Magalhães

Sousa

Oliveira

2012

Arq. Bras. Oftalmol.

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Regardless of significant progress in the field of corneal transplantation to treat cor neal opacification, some cases of corneal blindness still present a poor prognosis for conventional penetrating keratoplasty. In patients with repeated graft fai lure and/or with severe ocular surface disease, the Boston type I keratoprosthesis (type I BKPro) has become a viable option. Modifications in its design and postoperative management have improved the longterm outcomes of visual acuity, retention, and postoperative infection rates. These advances made the type I BKPro be considered a safe alternative for visual rehabilitation in many patients with corneal pathologies. However, postoperative handle of chronic comorbidities, such as glaucoma, is still critical for preserving the visual gains achieved with BKPro.

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“…Since this device bridges the non-sterile ocular surface with sterile anterior chamber, there is increased risk of rapid invasion of pathogenic organisms through the space between the tissue and the prosthesis [2]. Additionally, infectious endophthalmitis may occur months or years after K-Pro placement [3][4][5][6]. We report the clinical characteristics, management and outcomes of five patients who developed endophthalmitis following Boston K-Pro type 1.…”

Section: Introductionmentioning

confidence: 99%

Erratum to: Endophthalmitis in Boston keratoprosthesis: case series and review of literature

et al. 2015

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To report the clinical and microbiological characteristics of infectious endophthalmitis after Boston type I keratoprosthesis (B-K-Pro) implantation. Retrospective analysis of 45 eyes that received a B-K-Pro type 1 between 2009 and 2012 was performed. Five eyes with a diagnosis of exogenous endophthalmitis after B-K-pro type 1 were identified and information about demographic data, indication for K-Pro, post-operative bandage contact lens use, post-operative prophylactic antibiotic use, timing and clinical presentation of endophthalmitis, gram stain and culture results of intraocular fluid and preoperative and post-operative visual acuity were collected. The incidence of endophthalmitis was 11.1 % (5 of 45 eyes) and average time to develop endophthalmitis was 5.62 months (range 2 days to 8 months). Mean patient age was 31.4 years (5 to 65 years). The surgical indications included corneal injury due to chemical burns (n = 2), multiple failed grafts secondary to microbial keratitis (n = 2) and congenital glaucoma with congenital herpetic keratitis (n = 1). Post-Boston K-Pro, the visual acuity ranged from light perception (LP) to 20/50. K-pro was explanted in 4 patients. There was bacterial and fungal growth in two patients each and one vitreous did not grow anything. All the eyes were phthisical at last visit. Infectious endophthalmitis after K-Pro implantation in our study had a higher incidence, early onset and extremely poor visual outcome compared with post-cataract surgery endophthalmitis, as reported in literature. Not only bacterial but also fungal infections are an important etiology for infectious endophthalmitis in these cases.

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Successful Prevention of Bacterial Endophthalmitis in Eyes with the Boston Keratoprosthesis

Abstract: Topical vancomycin plus a quinolone is effective in preventing bacterial endophthalmitis in KPro eyes.

Cited by 139 publications

References 9 publications

Retinal detachments after Boston Keratoprosthesis: incidence, predisposing factors, and visual outcomes

Retinal detachments after Boston Keratoprosthesis: incidence, predisposing factors, and visual outcomes

Boston type I keratoprosthesis: Review

Erratum to: Endophthalmitis in Boston keratoprosthesis: case series and review of literature

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