波士顿 1 型角膜假体植入术后感染性角膜炎。

Infectious keratitis after Boston type 1 keratoprosthesis implantation.

机构信息

Cincinnati Eye Institute, Cincinnati, OH 41017, USA.

出版信息

Cornea. 2012 Oct;31(10):1128-34. doi: 10.1097/ICO.0b013e318245c02a.

DOI:10.1097/ICO.0b013e318245c02a

PMID:22960647

Abstract

PURPOSE

To determine the incidence, clinical features, and outcomes of infectious keratitis after Boston type 1 keratoprosthesis (Kpro) implantation.

METHODS

Ten cases of infectious keratitis were identified in a retrospective chart review of 105 patients (126 eyes) who received Kpro between November 2004 and November 2010 at the Cincinnati Eye Institute and were followed for at least 1 month (range, 1-66 months; mean, 25 months).

RESULTS

The incidence was 7.9%. Patient diagnoses included 4 chemical injuries, 3 Stevens-Johnson syndrome, 2 ocular cicatricial pemphigoid, and 1 congenital aniridia. Kpro implantation was indicated in 2 eyes for a failed ocular surface and in 8 for penetrating keratoplasty failure. Four patients were contact lens intolerant or noncompliant. All were on topical vancomycin and moxifloxacin for prophylaxis and 2 were on topical amphotericin for prophylaxis. Three infiltrates were culture negative, 5 were fungal (3 Candida, 1 Fusarium, 1 Dactylaria constricta), and 2 were bacterial (Rhodococcus equi and Gram-negative cocci). All patients were managed with topical agents and 4 were given an oral antifungal agent. Four patients had Kpro removal with therapeutic penetrating keratoplasty and 1 had Kpro replacement. At final follow-up, only 2 patients retained their preinfection best vision. Risk factors for infectious keratitis included a diagnosis of cicatrizing conjunctivitis (Stevens-Johnson syndrome, ocular cicatricial pemphigoid, or chemical injury) and a history of persistent epithelial defect (P = 0.0003 and 0.0142, respectively). Contact lens wear, vancomycin use, and a history of systemic immunosuppression (or use at the time of infection) were not statistically significant risk factors.

CONCLUSIONS

Infectious keratitis after Kpro can occur even when patients are on vancomycin and a fourth-generation fluoroquinolone for prophylaxis. Fungal organisms are a growing cause for concern, and we present the details of the first reported case of ocular D. constricta. The evolution of our management and prophylaxis strategy for fungal keratitis after Kpro implantation is also described.

摘要

目的

确定波士顿 1 型角膜假体（Kpro）植入术后感染性角膜炎的发生率、临床特征和结局。

方法

对 2004 年 11 月至 2010 年 11 月在辛辛那提眼研究所接受 Kpro 治疗的 105 例患者（126 只眼）进行回顾性图表分析，确定了 10 例感染性角膜炎病例，随访时间至少为 1 个月（范围为 1-66 个月；平均为 25 个月）。

结果

发病率为 7.9%。患者诊断包括 4 例化学伤、3 例史蒂文斯-约翰逊综合征、2 例眼瘢痕性类天疱疮和 1 例先天性无虹膜。2 只眼因眼表失败而植入 Kpro，8 只眼因穿透性角膜移植失败而植入 Kpro。4 例患者对隐形眼镜不耐受或不依从。所有患者均接受局部万古霉素和莫西沙星预防，2 例接受局部两性霉素预防。3 个浸润灶培养阴性，5 个为真菌（3 例为白色念珠菌、1 例为镰刀菌、1 例为束丝放线菌），2 个为细菌（马红球菌和革兰氏阴性球菌）。所有患者均接受局部药物治疗，4 例给予口服抗真菌药物。4 例患者行 Kpro 切除联合治疗性穿透性角膜移植，1 例患者行 Kpro 更换。最终随访时，仅 2 例患者保留了感染前的最佳视力。感染性角膜炎的危险因素包括瘢痕性结膜炎（史蒂文斯-约翰逊综合征、眼瘢痕性类天疱疮或化学伤）和持续性上皮缺损病史（P = 0.0003 和 0.0142）。隐形眼镜佩戴、万古霉素使用和全身免疫抑制史（或感染时使用）均不是统计学上的危险因素。