title: Microbial Keratitis and Endophthalmitis After the Boston Type 1 Keratoprosthesis.
abstract: OBJECTIVE
  To determine the incidence, ocular surface disease associations, microbiological profile, and clinical course of postoperative infections after implantation of the Boston type 1 keratoprosthesis (KPro-1).
  
  
  METHODS
  A retrospective chart review was conducted of all cases of the KPro-1 performed at a tertiary eye care center between January 1, 2008, and December 31, 2014.
  
  
  RESULTS
  Seventy-five KPro-1 procedures were included in the analysis. Postoperative infections occurred in 13 eyes (17.3%) with an incidence of 0.064 cases per eye-year. The Kaplan-Meier probability of an infection-free graft was 0.96, 0.90, 0.88, 0.87, and 0.86 at years 1 through 5, respectively. The rate of infections was greater in eyes with ocular surface disease (26.3% vs. 8.1%, P = 0.06), especially in those with a history of chemical or thermal injury or herpes zoster keratopathy (P = 0.001). There were 8 cases (10.7%) of microbial keratitis due to either fungi (5 cases) or bacteria (3 cases). There were 7 cases (9.3%) of endophthalmitis due to bacteria (5 cases) or intraocular extension of fungal keratitis (2 cases). The incidence of microbial keratitis and endophthalmitis was 0.034 and 0.03 cases per eye-year, respectively. Therapeutic management of the infected eyes required graft and device removal in 7 eyes (53.8%). After completion of microbiologic treatment, 7 eyes (53.8%) had lost more than 2 lines of the best-corrected preinfection visual acuity, including 5 eyes with endophthalmitis that had hand motion vision or worse.
  
  
  CONCLUSIONS
  Postoperative infections are a serious issue that compromises device retention and visual outcomes after keratoprosthesis implantation.
authors.affiliation: *Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, University of Iowa Carver College of Medicine, Iowa City, IA; and †Cornea Research Center, Stephen A. Wynn Institute for Vision Research, Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Wagoner
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Welder
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Goins
authors.forename: Mark A
authors.initials: MA
authors.lastname: Greiner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001187:Artificial Organs; D001705:Bioprosthesis; D002648:Child; D002675:Child, Preschool; D003315:Cornea; D003316:Corneal Diseases / Q000601:surgery; D003320:Corneal Ulcer / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D009877:Endophthalmitis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D014792:Visual Acuity
chemical_list: D000900:Anti-Bacterial Agents