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Infectious endophthalmitis in Boston keratoprosthesis: incidence and prevention
Author(s) -
Behlau Irmgard,
Martin Kathryn V.,
Martin Jacqueline N.,
Naumova Ele.,
Cadorette James J.,
Sforza J. Tammy,
Pineda Roberto,
Dohlman Claes H.
Publication year - 2014
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.12309
Subject(s) - endophthalmitis , medicine , incidence (geometry) , etiology , antibiotics , keratoprosthesis , cumulative incidence , surgery , transplantation , microbiology and biotechnology , visual acuity , biology , physics , optics
Purpose To determine the cumulative worldwide incidence of infectious endophthalmitis and associated vision loss after Boston keratoprosthesis (B‐ KP ro) 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‐ KP ro 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‐ KP ros 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‐ KP ros 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.