Department of Ophthalmology, Centre hospitalier de l'Université de Montréal, Montreal, Canada; and.
Department of Ophthalmology, King Abdulaziz University, Jeddah, Saudi Arabia.
Cornea. 2021 Oct 1;40(10):1258-1266. doi: 10.1097/ICO.0000000000002641.
To determine the incidence and recurrence of Boston type I keratoprosthesis (KPro)-associated endophthalmitis, and its microbiological profile, risk factors, and outcomes.
This is a retrospective study of 158 consecutive KPro procedures with a median follow-up of 78.4 months. Medical charts were reviewed for ocular history, contact lens and topical antibiotic use, visual acuity, and complications. For eyes with endophthalmitis, time to infection, culture results, and recurrences were collected. Cox regression analyses identified risk factors for endophthalmitis and compared the risk for visual failure, KPro retention, and globe loss between eyes with and without endophthalmitis.
The incidence and recurrence rates of endophthalmitis were of 1.7% and 6.0% per procedure-year, respectively. First episodes occurred at a median of 18.6 months. Eight of 18 episodes (44%) were culture positive, isolating mainly Gram-positive bacteria (7 [88%]). Previous ocular burn (hazard ratio: 7.34, 95% confidence interval: 1.91-28.15), infectious keratitis (5.09, 1.70-15.22), corneal melt (4.55, 1.50-13.83), and postoperative contact lens wear (4.19, 1.17-15.04) were risk factors. Eyes with endophthalmitis did not have a higher risk for visual failure (1.74, 0.78-3.91) but were more likely to not retain the KPro (2.81, 1.15-6.88) and undergo evisceration (2.81, 1.15-6.88). All eyes lost ≥ 2 lines of vision during the endophthalmitis episode.
Endophthalmitis is rare but vision and globe threatening in eyes with KPro. Given the increased associated risk, corneal melts and infectious keratitis must be promptly treated, postoperative contact lenses should be considered on a case-by-case basis, and patients with ocular burns might require more aggressive antimicrobial prophylaxis.
确定波士顿 I 型角膜假体（KPro）相关眼内炎的发生率和复发率，以及其微生物谱、危险因素和结局。
这是一项对 158 例连续 KPro 手术的回顾性研究，中位随访时间为 78.4 个月。回顾了眼部病史、接触镜和局部抗生素使用、视力和并发症的病历。对于患有眼内炎的眼睛，收集了感染时间、培养结果和复发情况。Cox 回归分析确定了眼内炎的危险因素，并比较了有和无眼内炎的眼睛的视力失败、KPro 保留和眼球丧失的风险。
眼内炎的发生率和复发率分别为每例手术 1.7%和 6.0%。首次发作的中位时间为 18.6 个月。18 例中的 8 例（44%）培养阳性，主要分离出革兰阳性菌（7 [88%]）。既往眼烧伤（危险比：7.34，95%置信区间：1.91-28.15）、感染性角膜炎（5.09，1.70-15.22）、角膜溶解（4.55，1.50-13.83）和术后接触镜佩戴（4.19，1.17-15.04）是危险因素。患有眼内炎的眼睛视力失败的风险并不更高（1.74，0.78-3.91），但更有可能无法保留 KPro（2.81，1.15-6.88）和接受眼球摘除（2.81，1.15-6.88）。所有眼内炎发作期间视力均下降≥2 行。
眼内炎虽然罕见，但对 KPro 眼有威胁视力和眼球的风险。鉴于相关风险增加，角膜溶解和感染性角膜炎必须及时治疗，术后接触镜应根据具体情况考虑，眼烧伤患者可能需要更积极的抗菌预防。
