Fungal Infections After Boston Type 1 Keratoprosthesis Implantation: Literature Review and In Vitro Antifungal Activity of Hypochlorous Acid.
OBJECTIVE
To review the current literature describing cases of fungal keratitis and endophthalmitis after Boston keratoprosthesis (KPro) implantation and to characterize the antifungal activity of 0.01% hypochlorous acid against medically relevant fungi.


METHODS
A literature review of fungal keratitis or endophthalmitis in KPro patients from January 2001 to April 2015, and an in vitro time kill assay characterizing the fungicidal activity of 0.01% hypochlorous acid against fungi causing ocular infections.


RESULTS
Fifteen publications, predominantly retrospective case series, were identified. Infection rates after KPro implantation ranged from 0.009 to 0.02 fungal infections per patient-year of follow-up. The largest single-surgeon series reported an incidence of 2.4% for fungal endophthalmitis during a 10-year period. Causative organisms included both yeasts and molds. Outcomes were favorable if infections were caught early and treated appropriately; less favorable outcomes were reported in developing countries where fungal species are endemic and resources are limited. 0.01% hypochlorous acid is rapidly fungicidal, reducing the number of viable yeast cells or mold conidia by at least 99.99% within 60 seconds. The antifungal activity extended to all molds (Acremonium kiliense, Aspergillus flavus, Aspergillus fumigatus, Fusarium solani, and Mucor indicus) and yeast species (Candida albicans and Candida parapsilosis) tested.


CONCLUSIONS
Fungal infections remain a lifelong concern in patients after KPro implantation. There is a growing need for a standard antifungal prophylaxis regimen, especially in the developing world. The rapid broad-spectrum in vitro fungicidal activity of 0.01% hypochlorous acid against all fungi tested makes it an attractive candidate as an antifungal prophylaxis in KPro patients.
*Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA; and †Department of Microbiology and Immunobiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.
Silvia
S
Odorcic
Wolfgang
W
Haas
Michael S
MS
Gilmore
Claes H
CH
Dohlman
D000935:Antifungal Agents / Q000494:pharmacology*; D001705:Bioprosthesis; D003316:Corneal Diseases / Q000601:surgery; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology; D009877:Endophthalmitis / Q000188:drug therapy* / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000382:microbiology; D005658:Fungi / Q000187:drug effects; D006801:Humans; D006997:Hypochlorous Acid / Q000494:pharmacology*; D016877:Oxidants / Q000494:pharmacology; D019919:Prosthesis Implantation; D012189:Retrospective Studies
D000935:Antifungal Agents; D016877:Oxidants; D006997:Hypochlorous Acid