Surveillance cultures of contact lenses of patients with Boston KPRO type keratoprosthesis

Purpose Patients with Type 1 Boston KPRO require the use of a contact lens to avoid complications of drying of the corneal tissue surrounding the KPro. Additionally, these patients require chronic use of topical antibiotics to reduce the ever‐present risk of endophthalmitis. This may promote the growth resistant organisms. The purpose of this study is to perform surveillance cultures of contact lenses of KPro patients to determine if organism growth may be detected prior to clinical presentation of infection. Methods Cultures of contact lenses from Boston KPro type 1 patients were performed. All patients were maintained on a prophylactic antibiotic regimen including vancomycin. All contact lenses were removed 1 week to 1 month after insertion. Removal prior to 1 month was necessary when excessive protein deposits were noted on the lens. Lenses were removed cultured and analyzed under electron microscopy. Results 45 patients with a KPro implanted in the last 18 months, the lenses of 15 patients were analyzed in the above manner. These 15 patients had various conditions including Stevens Johnson Syndrome, chemical burns, keratoconus, and multiple graft failures. Of the 15 lenses analyzed, one patient had cultures positive for streptococcus pneumonia, consistent with the patient's presentation of endophthalmitis. Three had cultures positive for coagulase negative staphylococcus although they did not present with any signs or symptoms of infection. Conclusion Surveillance cultures appear to be an effective way to monitor the contact lenses of Boston KPro patients for possible organism growth. The detection of these organisms prior to the clinical presentation of infection could serve as a signal to change the patient's antibiotic regimen.