Abstract
Purpose To identify the incidence of endophthalmitis and visual outcomes in eyes with Boston type 1 keratoprosthesis combined with pars plana vitrectomy and silicone oil insertion (KPro + PPV + SOI) as compared to eyes receiving Boston type 1 keratoprosthesis (KPro) alone. Patients and Methods Retrospective chart review of 29 eyes of 27 patients with KPro having at least 12-month follow-up. Thirteen of these eyes had hypotony and/or retinal detachment in addition to corneal pathology and thus received KPro + PPV + SOI. Polymyxin-trimethoprim with a quinolone was used as chronic topical antibiotic prophylaxis in both groups after the first postoperative month. Outcome measures recorded at the 1-, 3-, 6-, 12-, and 24-month follow-up visits included best-corrected visual acuity (BCVA) and rates of postoperative complications. Results All the patients had completed 24-month follow-up except one case in the KPro group who lost to follow-up after 12-month visit. In the KPro + PPV + SOI group, no eyes had developed endophthalmitis by the 24-month follow-up visit versus 5 eyes of 5 patients in the uncombined KPro group (P=0.048). The 2-year cumulative endophthalmitis incidence was 31.2% in the KPro group versus zero in the KPro + PPV + SOI group (P=0.030). Four of these 5 eyes had vitreous taps with positive cultures; 2 were positive with Staphylococcus aureus, 1 with coagulase-negative staphylococci, and 1 with Streptococcus pneumoniae. Other complications included KPro extrusion (1 in each group), retinal detachment (2 in the KPro and 1 in the KPro + PPV + SOI group), newly developed glaucoma (2 in each group), and retroprosthetic membrane (9 in the KPro and 5 in the KPro + PPV + SOI group). The KPro group had better average preoperative BCVA compared to those of the KPro + PPV + SOI group (−2.29 ± 0.72 LogMAR, versus −2.95 ± 0.30 LogMAR; P=0.004). No statistically significant difference in BCVA was noted in subsequent follow-up visits. Conclusion The addition of PPV and SOI to the KPro implantation in the eyes with corneal pathology, as well as hypotony and/or retinal detachment, is a safe and effective procedure for visual rehabilitation. Pars plana vitrectomy and silicone oil insertion may have a protective effect against the development of postoperative endophthalmitis in eyes receiving KPro.
Highlights
Introduction e Boston typeI keratoprosthesis (Massachusetts Eye and Ear Infirmary, Boston, MA; KPro) is the most widely used prosthetic corneal transplant in the United States and the world [1]
Long-term studies have shown a 7-year cumulative endophthalmitis incidence up to 15.5% after Boston type 1 KPro [4, 5] versus a 5-year cumulative incidence of 1.3% for bleb-related endophthalmitis [6] and 6.3% of endophthalmitis after glaucoma drainage device insertion [7], with both sharing the ongoing risk of infection and worse visual outcomes compared to infectious endophthalmitis after penetrating keratoplasty and cataract surgery. e KPro is a device, with limited biointegration, that bridges a nonsterile ocular surface with a sterile anterior chamber and can lead to rapid invasion of pathogenic organisms through the space between the tissue and the prosthesis [8]
We report our observation that patients with KPro combined with pars plana vitrectomy and silicone oil insertion have a lower incidence of infectious endophthalmitis than those with KPro alone
Summary
Mohamed Abou Shousha ,1,2 Taher Eleiwa ,2,3 Allister Gibbons ,2 Christopher Smith, Sean Edelstein, George Kontadakis ,2 Zachary Schmitz, Joshua Abernathy, Ross Chod, Zachary Bodnar, Kelvin McDaniel, Rocio Bentivegna, and Levent Akduman. Long-term studies have shown a 7-year cumulative endophthalmitis incidence up to 15.5% after Boston type 1 KPro [4, 5] versus a 5-year cumulative incidence of 1.3% for bleb-related endophthalmitis [6] and 6.3% of endophthalmitis after glaucoma drainage device insertion [7], with both sharing the ongoing risk of infection and worse visual outcomes compared to infectious endophthalmitis after penetrating keratoplasty and cataract surgery. We report our observation that patients with KPro combined with pars plana vitrectomy and silicone oil insertion have a lower incidence of infectious endophthalmitis than those with KPro alone. Past the 1-month follow-up visit, all patients were kept chronically on one regimen, polymyxin B sulfate and trimethoprim (Polytrim, Allergan Inc., Irvine, CA) and ofloxacin 0.3% (Ocuflox, Allergan, Irvine, CA) or moxifloxacin 0.5% (Vigamox, Alcon Inc., Fort Worth, TX) administered twice daily. Four patients in the KPro group and 6 patients in the KPro + PPV + SOI group did not use contact lenses chronically secondary to intolerance. ere were no persistent epithelial defects or infectious keratitis of the corneal carrier tissue noted in any of the included cases
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