Microbial Keratitis and Endophthalmitis After the Boston Type 1 Keratoprosthesis

Michael D Wagoner; Jeffrey D Welder; Kenneth M Goins; Mark A Greiner

doi:10.1097/ICO.0000000000000738

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Microbial Keratitis and Endophthalmitis After the Boston Type 1 Keratoprosthesis

Journal article

Peer reviewed

Microbial Keratitis and Endophthalmitis After the Boston Type 1 Keratoprosthesis

Michael D Wagoner, Jeffrey D Welder, Kenneth M Goins and Mark A Greiner

Cornea, Vol.35(4), pp.486-493

04/2016

DOI: 10.1097/ICO.0000000000000738

PMID: 26764885

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Abstract

To determine the incidence, ocular surface disease associations, microbiological profile, and clinical course of postoperative infections after implantation of the Boston type 1 keratoprosthesis (KPro-1). A retrospective chart review was conducted of all cases of the KPro-1 performed at a tertiary eye care center between January 1, 2008, and December 31, 2014. Seventy-five KPro-1 procedures were included in the analysis. Postoperative infections occurred in 13 eyes (17.3%) with an incidence of 0.064 cases per eye-year. The Kaplan-Meier probability of an infection-free graft was 0.96, 0.90, 0.88, 0.87, and 0.86 at years 1 through 5, respectively. The rate of infections was greater in eyes with ocular surface disease (26.3% vs. 8.1%, P = 0.06), especially in those with a history of chemical or thermal injury or herpes zoster keratopathy (P = 0.001). There were 8 cases (10.7%) of microbial keratitis due to either fungi (5 cases) or bacteria (3 cases). There were 7 cases (9.3%) of endophthalmitis due to bacteria (5 cases) or intraocular extension of fungal keratitis (2 cases). The incidence of microbial keratitis and endophthalmitis was 0.034 and 0.03 cases per eye-year, respectively. Therapeutic management of the infected eyes required graft and device removal in 7 eyes (53.8%). After completion of microbiologic treatment, 7 eyes (53.8%) had lost more than 2 lines of the best-corrected preinfection visual acuity, including 5 eyes with endophthalmitis that had hand motion vision or worse. Postoperative infections are a serious issue that compromises device retention and visual outcomes after keratoprosthesis implantation.

Prostheses and Implants

Artificial Organs

Cornea

Corneal Ulcer - epidemiology

Humans

Middle Aged

Child, Preschool

Bioprosthesis

Infant

Male

Eye Infections, Bacterial - drug therapy

Endophthalmitis - epidemiology

Incidence

Anti-Bacterial Agents - therapeutic use

Eye Infections, Bacterial - microbiology

Aged, 80 and over

Adult

Corneal Ulcer - microbiology

Eye Infections, Fungal - epidemiology

Female

Retrospective Studies

Child

Postoperative Complications

Endophthalmitis - drug therapy

Prosthesis Implantation

Visual Acuity

Corneal Diseases - surgery

Eye Infections, Fungal - microbiology

Corneal Ulcer - drug therapy

Endophthalmitis - microbiology

Eye Infections, Fungal - drug therapy

Adolescent

Aged

Eye Infections, Bacterial - epidemiology

Details

Title: Subtitle: Microbial Keratitis and Endophthalmitis After the Boston Type 1 Keratoprosthesis
Creators: Michael D Wagoner - University of Iowa, Ophthalmology and Visual Sciences
Jeffrey D Welder
Kenneth M Goins
Mark A Greiner
Resource Type: Journal article
Publication Details: Cornea, Vol.35(4), pp.486-493
Publisher: United States
DOI: 10.1097/ICO.0000000000000738
PMID: 26764885
ISSN: 0277-3740
eISSN: 1536-4798
Language: English
Date published: 04/2016
Academic Unit: Ophthalmology and Visual Sciences
Record Identifier: 9983980050102771

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