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Infectious endophthalmitis after boston type 1 keratoprosthesis implantation

机译：波士顿1型角膜假体植入后的感染性眼内炎

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摘要

PURPOSE: To determine the incidence, clinical features, and outcomes of infectious endophthalmitis after Boston Type 1 Keratoprosthesis (KPro) implantation. METHODS: Retrospective, consecutive case series. Chart review of 105 patients (126 eyes) who had KPro implantation at Cincinnati Eye Institute between November 2004 and November 2010 and who were followed up for at least 1 month (range, 1 month to 66 months; mean 25 months) revealed 3 cases who developed infectious endophthalmitis. RESULTS: One patient had a history of congenital glaucoma, and 2 patients had Stevens-Johnson syndrome. Two had KPro implantation for penetrating keratoplasty failure and 1 had necrosis of a previous KPro cornea. The incidence of endophthalmitis was 2.4%. All patients wore a contact lens and were on vancomycin and a fourth-generation fluoroquinolone (moxifloxacin). Vitreous fluid cultures yielded Ochrobactrum anthropi, Candida parapsilosis, and Candida albicans. All patients received intravitreal amphotericin, vancomycin, and/or ceftazidime. Topical and oral antiinfective agents were tailored based on sensitivities. One patient required KPro removal and therapeutic penetrating keratoplasty. Vision did not recover for 2 patients who presented with vision decreased to light perception. One patient, who presented with decreased vision of 20/400, recovered to 20/60. CONCLUSIONS: Infectious endophthalmitis is a devastating complication that can occur after Boston KPro implantation even with prophylactic vancomycin, a fourth-generation fluoroquinolone, and a therapeutic contact lens. Fungal and gram-negative organisms are a growing cause for concern. Further study is needed on optimal prophylaxis regimens, including the use of antifungals, especially for high-risk eyes, such as those with autoimmune cicatrizing disease.
机译：目的：确定波士顿1型角膜塑形假体（KPro）植入后感染性眼内炎的发生率，临床特征和结局。方法：回顾性，连续性病例系列。对2004年11月至2010年11月在辛辛那提眼科研究所接受KPro植入术的105例患者（126眼）进行的图表审查，随访了至少1个月（范围1个月至66个月;平均25个月），发现3例患者发生感染性眼内炎。结果：1例有先天性青光眼病史，2例史蒂文斯-约翰逊综合征。 2例因穿透性角膜移植失败而植入KPro，1例因先前的KPro角膜坏死。眼内炎的发生率为2.4％。所有患者均戴隐形眼镜，并接受万古霉素和第四代氟喹诺酮（莫西沙星）治疗。玻璃体液培养产生了人O骨，副念珠菌和白色念珠菌。所有患者均接受玻璃体内两性霉素，万古霉素和/或头孢他啶。根据敏感性调整局部和口服抗感染剂。一名患者需要移除KPro和穿透性角膜移植治疗。 2名视力下降至光线感知的患者视力未恢复。一名视力下降20/400的患者恢复到20/60。结论：传染性眼内炎是一种破坏性并发症，即使在预防性万古霉素，第四代氟喹诺酮和治疗性接触镜的情况下，波士顿KPro植入后也可能发生。真菌和革兰氏阴性生物越来越引起人们的关注。需要进一步研究最佳的预防方案，包括使用抗真菌剂，特别是对于高风险的眼睛，例如患有自身免疫性结石病的眼睛。

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