Abstract
Background
Although endophthalmitis is known to occur frequently in patients with KPros, the management remains a challenge both due to the lack of evidence and the exceptionality of the examination and the therapeutic approach.
Materials and methods
Three patients implanted with Boston keratoprosthesis for management of ocular cicatricial pemphigoid and severe alkali injury presented with severe late-onset (10–24 months post-operatively), presumed bacterial endophthalmitis. Three-port 25-gauge (g) pars plana vitrectomy was performed in all patients; vitreous samples were acquired and intravitreal vancomycin and cefuroxime were administered.
Results
Post-operative outcome was significantly improved in all three cases. Visual acuity improved from perception of light (PL) to 20/400 in the first, PL to counting fingers in the second and PL to 20/400 in the third patient.
Conclusion
We present our experience from managing presumed bacterial endophthalmitis with 25 g PPV in patients previously implanted with Boston Kpro, which to the best of our knowledge has not been reported before. Although the number of cases is small to draw accurate conclusions, we have to report that 25 g vitrectomy was performed without significant difficulties and seems to be a useful tool for the management of patients with Kpros requiring vitreoretinal surgery.
This is a preview of subscription content, log in via an institution to check access.
References
Dohlman CH, Schneider HA, Doane MG (1974) Prosthokeratoplasty. Am J Ophthalmol 77:694–670
Aldave AJ, Kamal KM, Vo RC, Yu F (2009) The Boston type I keratoprosthesis: improving outcomes and expanding indications. Ophthalmology 116:640–651, doi:S0161-6420(08)01358-4 [pii], 10.1016/j.ophtha.2008.12.058
Hicks CR, Fitton JH, Chirila TV, Crawford GJ, Constable IJ (1997) Keratoprostheses: advancing toward a true artificial cornea. Surv Ophthalmol 42:175–189, doi:S0039-6257(97)00024-6 [pii]
Doane MG, Dohlman CH, Bearse G (1996) Fabrication of a keratoprosthesis. Cornea 15:179–184
Barnham JJ, Roper-Hall MJ (1983) Keratoprosthesis: a long-term review. Br J Ophthalmol 67:468–474
Nouri M, Terada H, Alfonso EC, Foster CS, Durand ML, Dohlman CH (2001) Endophthalmitis after keratoprosthesis: incidence, bacterial causes, and risk factors. Arch Ophthalmol 119:484–489, doi:ecs00080 [pii]
Zerbe BL, Belin MW, Ciolino JB (2006) Results from the multicenter Boston type 1 keratoprosthesis study. Ophthalmology 113(1779):e1771–e1777, doi:S0161-6420(06)00676-2 [pii], 10.1016/j.ophtha.2006.05.015
Holak SA, Holak HM, Bleckmann H (2009) AlphaCor keratoprosthesis: postoperative development of six patients. Graefes Arch Clin Exp Ophthalmol 247:535–539, doi:10.1007/s00417-008-0964-7
Ray S, Khan BF, Dohlman CH, D’Amico DJ (2002) Management of vitreoretinal complications in eyes with permanent keratoprosthesis. Arch Ophthalmol 120:559–566, doi:ecs10200 [pii]
Fintelmann RE, Maguire JI, Ho AC, Chew HF, Ayres BD (2009) Characteristics of endophthalmitis in patients with the Boston keratoprosthesis. Cornea 28:877–878, doi:10.1097/ICO.0b013e31819b0385
Goldschmidt P, Degorge S, Benallaoua D, Basli E, Batellier L, Boutboul S, Allouch C, Borderie V, Laroche L, Chaumeil C (2009) New test for the diagnosis of bacterial endophthalmitis. Br J Ophthalmol 93:1089–1095, doi:bjo.2008.152181 [pii], 10.1136/bjo.2008.152181
Author information
Authors and Affiliations
Corresponding author
Additional information
No Proprietary or Financial interest
Rights and permissions
About this article
Cite this article
Georgalas, I., Kanelopoulos, A.J., Petrou, P. et al. Presumed endophthalmitis following Boston keratoprosthesis treated with 25 gauge vitrectomy: a report of three cases. Graefes Arch Clin Exp Ophthalmol 248, 447–450 (2010). https://doi.org/10.1007/s00417-009-1230-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-009-1230-3