title: Fungal keratitis with the type 1 Boston keratoprosthesis:  early Indian experience.
abstract: OBJECTIVE
  To report 2 cases of fungal keratitis and endophthalmitis in patients with the type 1 Boston keratoprosthesis (KPro) in India.
  
  
  METHODS
  Two patients underwent type 1 Boston KPro with uneventful intraoperative and early postoperative courses. The patients presented with keratitis and endophthalmitis within a few months after surgery. Both patients had soft bandage contact lenses in place and were on maintenance low-dose topical steroids and antibiotic eyedrops. Culture was positive for fungus in both the cases.
  
  
  RESULTS
  Despite aggressive antifungal medical therapy and surgical management, one patient's eye was eviscerated and the other lost the potential for any useful vision.
  
  
  CONCLUSIONS
  Fungal infection after KPro surgery can be devastating, negating the extraordinary visual recovery these patients achieve immediately after surgery. Chronic use of topical corticosteroids and broad-spectrum antibiotic and bandage contact lens, although indispensable, may enhance the risk of fungal infection especially in the endemic areas like India. The decision for KPro in such tropical climatic conditions should therefore be taken with absolute caution and frequent patient follow-up. A prophylactic antifungal regime may be mandatory when this procedure is undertaken in fungal endemic areas to improve outcomes.
authors.affiliation: Department of Cornea, Massachusetts Eye and ear infirmary, Boston, MA, USA.
authors.forename: Vandana
authors.initials: V
authors.lastname: Jain
authors.forename: Kanupriya
authors.initials: K
authors.lastname: Mhatre
authors.forename: Debraj
authors.initials: D
authors.lastname: Shome
authors.forename: Roberto
authors.initials: R
authors.lastname: Pineda
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001187:Artificial Organs / Q000009:adverse effects*; D001228:Aspergillosis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D001232:Aspergillus fumigatus / Q000302:isolation & purification; D003315:Cornea; D003316:Corneal Diseases / Q000601:surgery; D003320:Corneal Ulcer / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D003906:Developing Countries; D020878:Device Removal; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D014786:Vision Disorders / Q000534:rehabilitation
chemical_list: D000935:Antifungal Agents