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Infections after keratoprosthesis
1Cornea and External Disease Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
Purpose Of Review:
The purpose is to provide an overview of the recent advancements in the diagnosis and treatment of microbial keratitis and endophthalmitis after keratoprosthesis implantation.
Recent Findings:
The addition of vancomycin daily to a fluoroquinolone in the postoperative management of keratoprosthesis patients successfully reduced the number of cases of bacterial keratitis and endophthalmitis with an increased number of fungal infections now documented both in the United States and abroad.
Summary:
Compliance with the regimen of a fluoroquinolone and vancomycin daily for life after keratoprosthesis implantation should be stressed with the patient. Further research is needed to investigate whether intermittent use of 5% povidone-iodine and frequent replacement of the bandage contact lens could reduce fungal infection after keratoprosthesis surgery. Future advancements in the Boston keratoprosthesis design and/or postoperative management are needed to further reduce infection after keratoprosthesis placement.
Insights
Daily vancomycin with fluoroquinolone reduces bacterial infections after keratoprosthesis surgery but increases fungal cases. Lifelong adherence to this regimen is crucial for managing microbial keratitis and endophthalmitis.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Biomaterials Science
Background:
- Keratoprosthesis implantation is a sight-restoring procedure for severe corneal diseases.
- Infections, including microbial keratitis and endophthalmitis, remain significant complications.
- Post-keratoprosthesis infections pose challenges due to altered ocular anatomy and potential for resistant organisms.
Purpose of the Study:
- To review recent advancements in diagnosing and treating microbial keratitis and endophthalmitis following keratoprosthesis surgery.
- To highlight changes in infection patterns and effective management strategies.
- To identify areas for future research and development in keratoprosthesis care.
Main Methods:
- Review of recent literature on post-keratoprosthesis infections.
- Analysis of treatment outcomes with combined antibiotic regimens.
- Evaluation of emerging trends in microbial keratitis and endophthalmitis.
Main Results:
- Daily vancomycin combined with a fluoroquinolone significantly reduced bacterial keratitis and endophthalmitis.
- A notable increase in documented fungal infections has been observed post-operatively.
- This shift in infection profile necessitates a re-evaluation of prophylactic and therapeutic strategies.
Conclusions:
- Lifelong adherence to a fluoroquinolone and vancomycin regimen is essential for patients with keratoprosthesis.
- Further research into intermittent povidone-iodine use and bandage contact lens management may help mitigate fungal infections.
- Advancements in Boston keratoprosthesis design and postoperative care are needed to further minimize infection risks.
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