Successful prevention of bacterial endophthalmitis in eyes with the Boston keratoprosthesis.
OBJECTIVE
To determine the influence of topical vancomycin prophylaxis on the incidence of bacterial endophthalmitis in eyes with a Boston Keratoprosthesis (KPro).


METHODS
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.


RESULTS
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.


CONCLUSIONS
Topical vancomycin plus a quinolone is effective in preventing bacterial endophthalmitis in KPro eyes.
Durand
Marlene L
ML
Infectious Disease Unit, Massachusetts Eye and Ear Infirmary and Massachusetts General Hospital, Boston, MA 02114, USA. mdurand@partners.org
Dohlman
Claes H
CH
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control*; D002921:Cicatrix / Q000601:surgery; D003315:Cornea / Q000601:surgery*; D016039:Corneal Transplantation; D009877:Endophthalmitis / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control*; D004867:Equipment Design; D005126:Eye Burns / Q000601:surgery; D005128:Eye Diseases / Q000601:surgery; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000601:surgery; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology; D006095:Gram-Positive Cocci; D006801:Humans; D015994:Incidence; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology; D010390:Pemphigoid, Benign Mucous Membrane / Q000601:surgery; D019919:Prosthesis Implantation; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D014640:Vancomycin