Risk of Endophthalmitis in Boston Type 1 Keratoprosthesis Combined with Vitrectomy and Silicone Oil Insertion

Mohamed Abou Shousha, Taher Eleiwa, Allister Gibbons, Christopher Smith, Sean Edelstein, George Kontadakis, Zachary Schmitz, Joshua Abernathy, Ross Chod, Zachary Bodnar, Kelvin McDaniel, Rocio Bentivegna, Levent Akduman

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Abstract

Purpose. To identify the incidence of endophthalmitis and visual outcomes in eyes with Boston type 1 keratoprosthesis combined with pars plana vitrectomy and silicone oil insertion (KPro + PPV + SOI) as compared to eyes receiving Boston type 1 keratoprosthesis (KPro) alone. Patients and Methods. Retrospective chart review of 29 eyes of 27 patients with KPro having at least 12-month follow-up. Thirteen of these eyes had hypotony and/or retinal detachment in addition to corneal pathology and thus received KPro + PPV + SOI. Polymyxin-trimethoprim with a quinolone was used as chronic topical antibiotic prophylaxis in both groups after the first postoperative month. Outcome measures recorded at the 1-, 3-, 6-, 12-, and 24-month follow-up visits included best-corrected visual acuity (BCVA) and rates of postoperative complications. Results. All the patients had completed 24-month follow-up except one case in the KPro group who lost to follow-up after 12-month visit. In the KPro + PPV + SOI group, no eyes had developed endophthalmitis by the 24-month follow-up visit versus 5 eyes of 5 patients in the uncombined KPro group (P=0.048). The 2-year cumulative endophthalmitis incidence was 31.2% in the KPro group versus zero in the KPro + PPV + SOI group (P=0.030). Four of these 5 eyes had vitreous taps with positive cultures; 2 were positive with Staphylococcus aureus, 1 with coagulase-negative staphylococci, and 1 with Streptococcus pneumoniae. Other complications included KPro extrusion (1 in each group), retinal detachment (2 in the KPro and 1 in the KPro + PPV + SOI group), newly developed glaucoma (2 in each group), and retroprosthetic membrane (9 in the KPro and 5 in the KPro + PPV + SOI group). The KPro group had better average preoperative BCVA compared to those of the KPro + PPV + SOI group (-2.29 ± 0.72 LogMAR, versus -2.95 ± 0.30 LogMAR; P=0.004). No statistically significant difference in BCVA was noted in subsequent follow-up visits. Conclusion. The addition of PPV and SOI to the KPro implantation in the eyes with corneal pathology, as well as hypotony and/or retinal detachment, is a safe and effective procedure for visual rehabilitation. Pars plana vitrectomy and silicone oil insertion may have a protective effect against the development of postoperative endophthalmitis in eyes receiving KPro.

Original languageEnglish (US)
Article number9648614
JournalJournal of Ophthalmology
Volume2019
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

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ASJC Scopus subject areas

  • Ophthalmology

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Shousha, M. A., Eleiwa, T., Gibbons, A., Smith, C., Edelstein, S., Kontadakis, G., Schmitz, Z., Abernathy, J., Chod, R., Bodnar, Z., McDaniel, K., Bentivegna, R., & Akduman, L. (2019). Risk of Endophthalmitis in Boston Type 1 Keratoprosthesis Combined with Vitrectomy and Silicone Oil Insertion. Journal of Ophthalmology, 2019, [9648614]. https://doi.org/10.1155/2019/9648614