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首页> 外文期刊>Cornea >Infectious keratitis after boston type 1 keratoprosthesis implantation
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Infectious keratitis after boston type 1 keratoprosthesis implantation

机译：波士顿1型角膜假体植入后的感染性角膜炎

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PURPOSE: To determine the incidence, clinical features, and outcomes of infectious keratitis after Boston type 1 keratoprosthesis (Kpro) implantation. METHODS: Ten cases of infectious keratitis were identified in a retrospective chart review of 105 patients (126 eyes) who received Kpro between November 2004 and November 2010 at the Cincinnati Eye Institute and were followed for at least 1 month (range, 1-66 months; mean, 25 months). RESULTS: The incidence was 7.9%. Patient diagnoses included 4 chemical injuries, 3 Stevens-Johnson syndrome, 2 ocular cicatricial pemphigoid, and 1 congenital aniridia. Kpro implantation was indicated in 2 eyes for a failed ocular surface and in 8 for penetrating keratoplasty failure. Four patients were contact lens intolerant or noncompliant. All were on topical vancomycin and moxifloxacin for prophylaxis and 2 were on topical amphotericin for prophylaxis. Three infiltrates were culture negative, 5 were fungal (3 Candida, 1 Fusarium, 1 Dactylaria constricta), and 2 were bacterial (Rhodococcus equi and Gram-negative cocci). All patients were managed with topical agents and 4 were given an oral antifungal agent. Four patients had Kpro removal with therapeutic penetrating keratoplasty and 1 had Kpro replacement. At final follow-up, only 2 patients retained their preinfection best vision. Risk factors for infectious keratitis included a diagnosis of cicatrizing conjunctivitis (Stevens-Johnson syndrome, ocular cicatricial pemphigoid, or chemical injury) and a history of persistent epithelial defect (P = 0.0003 and 0.0142, respectively). Contact lens wear, vancomycin use, and a history of systemic immunosuppression (or use at the time of infection) were not statistically significant risk factors. CONCLUSIONS: Infectious keratitis after Kpro can occur even when patients are on vancomycin and a fourth-generation fluoroquinolone for prophylaxis. Fungal organisms are a growing cause for concern, and we present the details of the first reported case of ocular D. constricta. The evolution of our management and prophylaxis strategy for fungal keratitis after Kpro implantation is also described.
机译：目的：确定波士顿1型角膜假体（Kpro）植入后感染性角膜炎的发生率，临床特征和结局。方法：回顾性分析了2004年11月至2010年11月间在辛辛那提眼科研究所接受Kpro的105例患者（126眼）中的10例感染性角膜炎，并随访了至少1个月（1-66个月） ;平均为25个月）。结果：发生率为7.9％。患者诊断包括4例化学损伤，3例Stevens-Johnson综合征，2眼瘢痕性天疱疮和1例先天性无虹膜。 Kpro植入在2眼中表示为眼表衰竭，在8眼中表示为穿透性角膜移植失败。四名患者是隐形眼镜不耐受或不依从。全部使用局部万古霉素和莫西沙星预防，使用2种两性霉素进行预防。 3次浸润为培养阴性，5次为真菌（3例念珠菌，1种镰刀菌，1株Dactylaria constricta），2次为细菌（马氏红球菌和革兰氏阴性球菌）。所有患者均接受局部用药治疗，4例接受口服抗真菌药治疗。 4例患者通过治疗性穿透性角膜移植术去除了Kpro，1例进行了Kpro置换。在最后的随访中，只有2例患者保留了感染前的最佳视力。感染性角膜炎的危险因素包括诊断结节性结膜炎（史蒂文斯-约翰逊综合征，眼结石性天疱疮或化学性损伤）和持续性上皮缺损病史（分别为P = 0.0003和0.0142）。隐形眼镜佩戴，使用万古霉素和全身免疫抑制史（或感染时使用）均不是统计学上显着的危险因素。结论：即使在患者接受万古霉素和第四代氟喹诺酮类药物预防的情况下，Kpro后仍可能发生感染性角膜炎。真菌是引起人们越来越多关注的原因，我们将介绍第一例眼D. constricta病例的详细信息。还介绍了Kpro植入后我们对真菌性角膜炎的管理和预防策略的演变。

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