Infectious endophthalmitis in Boston keratoprosthesis: incidence and prevention.

Abstract

PURPOSE:

To determine the cumulative worldwide incidence of infectious endophthalmitis and associated vision loss after Boston keratoprosthesis (B-KPro) Type I/II implantation and to propose both safe and inexpensive prophylactic antibiotic regimens.

METHODS:

Two retrospective methods were used to determine the incidence, visual outcomes and aetiologies of infectious endophthalmitis associated with the B-KPro divided per decade: (i) systematic review of the literature from 1990 through January 2013 and (ii) a surveillance survey sent to all surgeons who implanted B-KPros through 2010 with 1-year minimum follow-up. In addition, a single-Boston surgeon 20-year experience was examined.

RESULTS:

From 1990 through 2010, there were 4729 B-KPros implanted worldwide by 209 U.S. surgeons and 159 international surgeons. The endophthalmitis cumulative mean incidence declined from 12% during its first decade of use to about 3% during its second decade in the Unites States and about 5% internationally during the second decade. There remains a large incidence range both in the United States (1-12.5%) and internationally (up to 17%). Poor compliance with daily topical antibiotics is an important risk factor. While Gram-positive organisms remained dominant, fungal infections emerged during the second decade.

CONCLUSIONS:

Daily prophylactic topical antibiotics have dramatically reduced the endophthalmitis incidence. Although Gram-positive organisms are the most common aetiology, antimicrobials must be inclusive of Gram-negative organisms. Selection of prophylactic regimens should be tailored to local antibiotic susceptibility patterns, be cost-effective, and should not promote the emergence of antimicrobial resistance. An example of a broad-spectrum, low-cost prophylactic option for non-autoimmune patients includes trimethoprim/polymyxinB once daily.

• Authors: Irmgard Behlau, Kathryn V Martin, Jacqueline N Martin, Elena N Naumova, James J Cadorette, J Tammy Sforza, Roberto Pineda 2nd, Claes H Dohlman
• Journal: Acta ophthalmologica (Acta Ophthalmol) Vol. 92 Issue 7 Pg. e546-55 (Nov 2014) ISSN: 1755-3768 [Electronic] England
• PMID: 24460594 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Topics

• Antibiotic Prophylaxis
• Bioartificial Organs
• Cornea
• Endophthalmitis (epidemiology, microbiology, prevention & control)
• Eye Infections, Bacterial (epidemiology, microbiology, prevention & control)
• Eye Infections, Fungal (epidemiology, microbiology, prevention & control)
• Global Health
• Humans
• Incidence
• Prosthesis Implantation
• Retrospective Studies
• Risk Factors
• United States (epidemiology)
• Visual Acuity (physiology)