Successful prevention of bacterial endophthalmitis in eyes with the Boston keratoprosthesis.

Abstract

PURPOSE:

To determine the influence of topical vancomycin prophylaxis on the incidence of bacterial endophthalmitis in eyes with a Boston Keratoprosthesis (KPro).

METHODS:

A retrospective chart review was performed for 255 eyes of 231 patients who received a KPro between March 1990 and December 2006. Preoperative diagnoses were burn, ocular cicatricial pemphigoid (OCP), Stevens-Johnson Syndrome (SJS), and graft failure/other. Patients used topical antibiotic prophylaxis for the duration of the KPro: polymyxin-trimethoprim or a quinolone in the 1990s, or a quinolone with or without vancomycin beginning in late 1999. For each KPro eye, the follow-up interval was divided into months on or off vancomycin (vancomycin versus no-vancomycin group). The incidence of endophthalmitis was calculated with Kaplan-Meier survival curves.

RESULTS:

The 255 eyes were followed for 673.6 patient-years (mean, 2.64 years; range, 1 week to 13 years). There were 18 cases of bacterial endophthalmitis; 17 occurred at least 6 weeks postoperatively (range, 1.5 to 46 months). Gram-positive cocci caused over 80% of cases. Only 1 case, due to an atypical mycobacterium, occurred in a patient using vancomycin.The incidence of bacterial endophthalmitis was lower in the vancomycin group than in the no-vancomycin group: 0.35% versus 4.13% per patient-year (P = 0.001). It was also lower in SJS eyes using vancomycin versus no vancomycin: 1.76% versus 18.39% per patient-year (P = 0.009). In eyes with preoperative diagnoses of burn, OCP, or graft failure/other, the incidence in the vancomycin group was zero.

CONCLUSION:

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

• Authors: Marlene L Durand, Claes H Dohlman
• Journal: Cornea (Cornea) Vol. 28 Issue 8 Pg. 896-901 (Sep 2009) ISSN: 1536-4798 [Electronic] United States
• PMID: 19654525 (Publication Type: Journal Article)

Chemical References

• Anti-Bacterial Agents
• Vancomycin

Topics

• Anti-Bacterial Agents (therapeutic use)
• Antibiotic Prophylaxis
• Bacterial Infections (epidemiology, prevention & control)
• Cicatrix (surgery)
• Cornea (surgery)
• Corneal Transplantation
• Endophthalmitis (epidemiology, microbiology, prevention & control)
• Equipment Design
• Eye Burns (surgery)
• Eye Diseases (surgery)
• Follow-Up Studies
• Graft Rejection (surgery)
• Gram-Positive Bacterial Infections (epidemiology)
• Gram-Positive Cocci
• Humans
• Incidence
• Mycobacterium Infections, Nontuberculous (epidemiology)
• Pemphigoid, Benign Mucous Membrane (surgery)
• Prosthesis Implantation
• Prosthesis-Related Infections (epidemiology, prevention & control)
• Retrospective Studies
• Stevens-Johnson Syndrome (surgery)
• Time Factors
• Treatment Outcome
• Vancomycin (therapeutic use)