This retrospective study in the April issue of Ophthalmology shows that infectious endophthalmitis following Boston type 1 keratoprosthesis occurs at a higher rate than with more common intraocular procedures, such as cataract surgery.
The authors recommend the concurrent use of topical vancomycin following K-Pro implantation because it seems to reduce the incidence and recurrence of endophthalmitis and because fluoroquinolone ophthalmic drops do not seem to provide sufficient prophylaxis in these eyes.
The authors reviewed the charts of the 130 adult patients (141 eyes) who received a K-Pro at one institution from May 2004 through July 2008. This is the largest review of eyes implanted with a K-Pro to report on the incidence of endophthalmitis at a single center, which allowed for a fairly uniform operating room protocol, surgical procedure and follow-up for each eye.
Ten (7.1 percent) of these eyes were diagnosed and treated for bacterial endophthalmitis. The average time to endophthalmitis development after K-Pro implantation was 9.8 months (standard deviation [SD], 6.2 months; range, 2-25 months). Coagulase-negative staphylococci were identified in seven eyes.
Endophthalmitis recurred in seven of 10 eyes a mean of four months (SD, 3.9 months; range, 1-13 months) after resolution of the initial episode. During the study's two-year follow-up, one eye experienced a third occurrence.
At each episode of endophthalmitis, most eyes were receiving only fluoroquinolone ophthalmic drops for prophylaxis and no eye was receiving vancomycin ophthalmic drops.
The authors cite a number of risk factors that may have contributed to infection recurrence, including insufficient use of antibiotic prophylaxis, failure to treat and eradicate the inciting organism fully after the initial episode, K-Pro or eye wall compromise, and improper contact lens hygiene. To avoid endophthalmitis after K-Pro implantation, they recommend topical vancomycin use, patient education, adherence to bandage contact lens hygiene and careful monitoring for areas of thinning or leakage around the K-Pro.