Characteristics of endophthalmitis in patients with the Boston keratoprosthesis.
OBJECTIVE
To determine the characteristics of endophthalmitis in patients with the Boston keratoprosthesis.


METHODS
Retrospective chart review of 4 out of 35 patients who underwent implantation of the Boston keratoprosthesis on the Wills Eye Cornea service between 2001 and 2007 and developed infectious endophthalmitis.


RESULTS
All 4 patients had keratoprosthesis surgery due to previous corneal transplant failure. The incidence of endophthalmitis was 11.4%. All patients were on topical antibiotic prophylaxis with a fluoroquinolone and 1 of the 4 patients was also using vancomycin drops. All 4 patients underwent a tap and inject and were admitted for intensive intravenous and topical antibiotics for 3 to 7 days. Culture positive results were found in 3 of the 4 vitreous samples: 2 coagulase-negative Staphylococcus, and 1 Pseudomonas and Staphylococcus aureus. Minimum Inhibitory Concentration data showed high resistance to fourth-generation fluoroquinolone antibiotics in all isolates. All patients recovered significant vision, except 1 patient who developed fluctuating vision secondary to vitreoretinal traction bands, which developed secondary to the endophthalmitis.


CONCLUSIONS
Endophthalmitis can occur after Boston keratoprosthesis at a significant rate, even in low-risk patients on prophylactic antibiotic drops. Given our experience with these patients and vancomycin, we recommend its prophylactic use. The increasing resistance of gram-positive organisms to fluoroquinolones and the need for close patient follow-up to encourage adherence to preventive regimens are further supported in this report.
Fintelmann
Robert E
RE
Cornea Service and Retina Service, Wills Eye Institute, Philadelphia, PA 19107, USA.
Maguire
Joseph I
JI
Ho
Allen C
AC
Chew
Hall F
HF
Ayres
Brandon D
BD
D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D003030:Coagulase / Q000172:deficiency; D003315:Cornea / Q000601:surgery*; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000150:complications / Q000453:epidemiology / Q000382:microbiology*; D005128:Eye Diseases / Q000209:etiology; D024841:Fluoroquinolones / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D019919:Prosthesis Implantation; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000382:microbiology; D011549:Pseudomonas / Q000502:physiology; D011552:Pseudomonas Infections / Q000382:microbiology; D012164:Retinal Diseases / Q000209:etiology; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000382:microbiology; D013210:Staphylococcus / Q000378:metabolism / Q000502:physiology; D013211:Staphylococcus aureus / Q000502:physiology; D014640:Vancomycin / Q000008:administration & dosage; D014822:Vitreous Body
D000900:Anti-Bacterial Agents; D003030:Coagulase; D024841:Fluoroquinolones; D014640:Vancomycin