Infectious endophthalmitis in Boston keratoprosthesis: incidence and prevention.

Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101468102 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1755-3768 (Electronic) Linking ISSN: 1755375X NLM ISO Abbreviation: Acta Ophthalmol Subsets: MEDLINE

Publication: Oxford, UK : Wiley-Blackwell
Original Publication: Oxford, UK ; Malden, MA : Blackwell Munksgaard

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

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.
(© 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Keywords: Boston keratoprosthesis; endophthalmitis; ocular infections; ocular prophylaxis

Date Created: 20140128 Date Completed: 20150409 Latest Revision: 20220316

20250114

10.1111/aos.12309

24460594