Microbial Infections After Boston Keratoprosthesis: A Case Series

Abstract

Purpose: This article presents a case series of microbial keratitis in eyes that underwent Boston keratoprosthesis implantation. Methods: A thorough examination of medical records and microbiology results was conducted for patients who experienced microbial keratitis subsequent to Boston keratoprosthesis (KPro) implantation from July 2019 to July 2023. Results: The review included 3 eyes of 3 distinct patients. In case 1, a patient with a history of chemical burns in the right eye underwent type I KPro implantation. Infectious keratitis, caused by Corynebacterium amycolatum, developed 9 years post-implantation. Despite the keratitis, the KPro remained in place, and treatment with vancomycin and ceftazidime agents, along with a C-collar full-thickness corneal graft for corneal melt, was administered. In case 2, Streptococcus pneumoniae-induced keratitis occurred 2 months following a type I KPro implantation. The infiltration resolved entirely after 4 weeks of topical and systemic antimicrobial treatment. Case 3 involved a patient with a history of Stevens-Johnson syndrome who underwent type II KPro implantation with autologous auricular cartilage reinforcement in the left eye. Bacterial keratitis and endophthalmitis caused by Streptococcus mitis/oralis developed 2 years after the surgery, ultimately resulting in phthisis. Conclusions: Both C. amycolatum and S. mitis/oralis can breach commensalism barriers, leading to opportunistic infections in eyes with implanted keratoprosthesis and compromised ocular surfaces. Post-keratoprosthesis microbial keratitis remains a significant concern and is often associated with adverse outcomes.