Cornea Service, The Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, California.
Ophthalmology. 2013 Nov;120(11):2209-16. doi: 10.1016/j.ophtha.2013.05.001. Epub 2013 Jun 6.
To identify the incidence of and risk factors for microbial keratitis after implantation of the Boston type I keratoprosthesis (Massachusetts Eye and Ear Infirmary, Boston, MA).
Retrospective, single-surgeon consecutive case series.
A total of 105 patients (125 keratoprosthesis procedures in 110 eyes) who underwent Boston type I keratoprosthesis implantation at the Jules Stein Eye Institute between May 1, 2004, and April 1, 2012.
Data regarding ocular history, relevant intraoperative data, postoperative management, and outcomes were collected for each procedure. Risk factor analyses were performed using the Fisher exact test, log-rank test, and hazard ratio (HR).
Incidence of microbial keratitis, organisms responsible, risk factors, and outcomes.
During the period under review, 20 presumed infectious infiltrates were diagnosed in 15 eyes (13.6%) of 15 patients (14.3%), for a rate of 0.073 infections per eye-year. The rate of culture-positive bacterial keratitis was 0.022 infections per eye-year, and the rate of culture-positive fungal keratitis was 0.015 infections per eye-year. Topical vancomycin use, topical steroid use, and contact lens wear did not increase the incidence of infectious keratitis, but prolonged vancomycin use was associated with an increased risk for fungal keratitis and infectious keratitis overall. Persistent corneal epithelial defect formation also was associated with an increased incidence of fungal keratitis and infectious keratitis overall. There were no cases of endophthalmitis resulting from infectious keratitis.
Infectious keratitis develops in 13.6% of eyes after keratoprosthesis implantation, with a similar rate of culture-positive bacterial and fungal keratitis. The observed rate of microbial keratitis suggests the need for additional topical antimicrobial prophylaxis after keratoprosthesis implantation in eyes at higher risk, such as those with persistent corneal epithelial defect formation or prolonged vancomycin use.
确定波士顿 I 型角膜假体（马萨诸塞州眼耳研究所，波士顿，MA）植入后微生物性角膜炎的发生率和危险因素。
回顾性、单外科医生连续病例系列。
2004 年 5 月 1 日至 2012 年 4 月 1 日，在朱尔斯·斯坦因眼科研究所接受波士顿 I 型角膜假体植入的 105 名患者（110 只眼共 125 例角膜假体手术）。
收集了每例手术的眼部病史、相关术中数据、术后管理和结果的数据。使用 Fisher 精确检验、对数秩检验和风险比（HR）进行危险因素分析。
微生物性角膜炎的发生率、致病微生物、危险因素和结局。
在审查期间，15 名患者（14.3%）的 15 只眼中诊断出 20 例疑似感染性浸润（13.6%），每只眼年感染率为 0.073 例。培养阳性细菌性角膜炎的发生率为每只眼年 0.022 例，培养阳性真菌性角膜炎的发生率为每只眼年 0.015 例。局部万古霉素使用、局部皮质类固醇使用和角膜接触镜佩戴并未增加感染性角膜炎的发生率，但万古霉素使用时间延长与真菌性角膜炎和总体感染性角膜炎的风险增加相关。持续性角膜上皮缺损的形成也与真菌性角膜炎和总体感染性角膜炎的发生率增加相关。没有因感染性角膜炎导致眼内炎的病例。
角膜假体植入后，13.6%的眼睛发生感染性角膜炎，细菌性和真菌性角膜炎的培养阳性率相似。观察到的微生物性角膜炎发生率表明，对于存在持续性角膜上皮缺损形成或万古霉素使用时间延长等更高风险的眼，需要在角膜假体植入后增加局部抗菌预防。
