Successful Prevention of Bacterial Endophthalmitis in Eyes with the Boston Keratoprosthesis
- 1 September 2009
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Cornea
- Vol. 28 (8), 896-901
- https://doi.org/10.1097/ico.0b013e3181983982
Abstract
To determine the influence of topical vancomycin prophylaxis on the incidence of bacterial endophthalmitis in eyes with a Boston Keratoprosthesis (KPro). A retrospective chart review was performed for 255 eyes of 231 patients who received a KPro between March 1990 and December 2006. Preoperative diagnoses were burn, ocular cicatricial pemphigoid (OCP), Stevens-Johnson Syndrome (SJS), and graft failure/other. Patients used topical antibiotic prophylaxis for the duration of the KPro: polymyxin-trimethoprim or a quinolone in the 1990s, or a quinolone with or without vancomycin beginning in late 1999. For each KPro eye, the follow-up interval was divided into months on or off vancomycin (vancomycin versus no-vancomycin group). The incidence of endophthalmitis was calculated with Kaplan-Meier survival curves. The 255 eyes were followed for 673.6 patient-years (mean, 2.64 years; range, 1 week to 13 years). There were 18 cases of bacterial endophthalmitis; 17 occurred at least 6 weeks postoperatively (range, 1.5 to 46 months). Gram-positive cocci caused over 80% of cases. Only 1 case, due to an atypical mycobacterium, occurred in a patient using vancomycin.The incidence of bacterial endophthalmitis was lower in the vancomycin group than in the no-vancomycin group: 0.35% versus 4.13% per patient-year (P = 0.001). It was also lower in SJS eyes using vancomycin versus no vancomycin: 1.76% versus 18.39% per patient-year (P = 0.009). In eyes with preoperative diagnoses of burn, OCP, or graft failure/other, the incidence in the vancomycin group was zero. Topical vancomycin plus a quinolone is effective in preventing bacterial endophthalmitis in KPro eyes.Keywords
This publication has 9 references indexed in Scilit:
- Importance of Nutrition to Corneal Grafts When Used as a Carrier of the Boston KeratoprosthesisCornea, 2007
- Fungal Colonization and Infection in Boston KeratoprosthesisCornea, 2007
- Introduction to the use of the Boston keratoprosthesisExpert Review of Ophthalmology, 2006
- Late-Onset Blebitis/Endophthalmitis: Incidence and Outcomes with Mitomycin COptometry and Vision Science, 2004
- Incidence of Late-Onset Bleb-Related Complications Following Trabeculectomy With MitomycinAmerican Journal of Ophthalmology, 2002
- Endophthalmitis After KeratoprosthesisAmerican Journal of Ophthalmology, 2001
- Keratoprosthesis: Preoperative Prognostic CategoriesCornea, 2001
- Delayed-onset Endophthalmitis Associated with Conjunctival Filtering BlebsOphthalmology, 1997
- Microbiologic Factors and Visual Outcome in the Endophthalmitis Vitrectomy StudyAmerican Journal of Ophthalmology, 1996