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Endophthalmitis in eyes with Boston Type 1 and modified osteo-odonto keratoprosthesis

Session Details

Session Title: Vitreoretinal Surgery IV

Session Date/Time: Sunday 20/09/2015 | 09:00-10:30

Paper Time: 09:32

Venue: Thalie.

First Author: : E.Rishi INDIA

Co Author(s): :    P. Rishi   V. Koudanya           

Abstract Details

PURPOSE:To report the incidence, clinical features, risk factors, causative organisms and treatment outcomes of endophthalmitis following Boston Type 1 and Modified Osteo-odonto Keratoprosthesis (K-Pro) implantation

Setting:

Single centre, retrospective, interventional case series at a tertiary ophthalmic centre

Methods:

145 eyes receiving K-pro either Boston K-Pro (BKP) (n= 54) or Modified Osteo-Odonto K-Pro (MOOKP) (n=91) at a single centre from Jan 2005 to Jan 2014 were included in the study. Amongst these eyes, patients with endophthalmitis were identified and were reviewed for demographic data, indication for K-Pro, timing and clinical presentation of endophthalmitis, microscopy and culture results of intraocular fluid, treatment given and pre and post-treatment functional and anatomical outcome.

Results:

16 eyes (BKP=8; MOOKP=8) developed endophthalmitis following permanent keratoprosthesis. Indication for BKP were chemical injury (n=6) and multiple failed graft (n=2) and for MOOKP was Steven-Johnson Syndrome (n=8). The average interval between K-Pro implantation and endophthalmitis in BKP eyes was 10 months (Median: 8.5) and for MOOKP eyes 28 months (Median: 19). Risk factors for endophthalmitis in eyes with BKP were chemical injury (OR=6; p=0.03), graft host junction melt/leak (OR=10; p=0.009) and persistent epithelial defect (OR=11; p=0.004) while for MOOKP eyes, SJS (OR=19; p=0.04), lamina resorption (OR=90; p=0.0001), lamina exposure (OR=6; p=0.03), mucous membrane graft necrosis (OR=20; p=0.0006) and sterile vitritis (OR=6; CI: p=0.02). None of 26 eyes with silicone oil in situ developed endophthalmitis. In eyes with BKP, fungi were the most common isolates (n=6) whereas gram positive bacteria were the most common isolates (n=7) in MOOKP eyes. Vitrectomy was done in 5 eyes with BKP, with 3 requiring K-pro removal. 2 eyes were eviscerated while 1 eye was managed medically. Functional visual acuity was achieved in 3/6 (50%) treated eyes. 4 MOOKP eyes were managed medically, 1 had extrusion of lamina, 1 needed lamina removal and 3 were eviscerated. Functional visual acuity was achieved in 1 (12%) eyes.

Conclusions:

The incidence of endophthalmitis in patients with BKP and MOOKP was 15% and 9%, respectively. The onset of endophthalmitis was earlier in eyes with BKP. Chemical injury, persistent epithelial defect and graft/host junction melt/leak are important risk factors for endophthalmitis following BKP while SJS, lamina resorption/exposure, MMG necrosis and sterile vitritis are important risk factors following MOOKP. Silicone oil in situ appears to have a protective role in such eyes. Fungal infections are seen more often in eyes with BKP while gram positive bacteria are more common in eyes with MOOKP. Patients with K-pro have a grave prognosis following endophthalmitis but with early identification of risk factors and prompt intervention such eyes can be salvaged. We allude to a combined surgical intervention with anterior segment expert for improving outcomes. Further studies are needed for optimal prophylaxis regimens, including the use of antifungals.

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