Fungal keratitis with the type 1 Boston keratoprosthesis: early Indian experience

To report 2 cases of fungal keratitis and endophthalmitis in patients with the type 1 Boston keratoprosthesis (KPro) in India.

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.

Despite aggressive antifungal medical therapy and surgical management, one patient's eye was eviscerated and the other lost the potential for any useful vision.

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.