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R. S. Ramchandran, J. V. Aquavella, R. P. Plotnik, M. M. Chung, D. M. Kleinman, P. Graman, D. A. Diloreto, Jr.; Infectious Endophthalmitis in Adult Eyes Receiving Dohlman Type I Keratoprosthesis. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3553.
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To report on the occurrence and clinical course of infectious endophthalmitis after Dohlman type I keratoprosthesis (K-Pro) implantation.
A retrospective chart review of all eyes receiving a K-Pro at the University of Rochester Eye Institute from January 2005 and September 2007 was conducted to identify cases treated for bacterial endophthalmitis. These cases were further reviewed for specific details including demographic data, indication for K-Pro, contact lens and prophylactic antibiotic use in the K-Pro eye, timing and clinical presentation of endophthalmitis after K-Pro implantation, gram stain and culture results of intraocular fluid, timing and presentation of any further episodes of endophthalmitis (recurrent endophthalmitis), and preoperative and postoperative visual acuity at all relevant time points.
Ten out of 141 eyes (7.1%) of 130 adult patients were diagnosed and treated for bacterial endophthalmitis. Reasons for K-Pro implantation were failed corneal transplants (6), Fuchs dystrophy (1), lattice dystrophy (1), pseudophakic bullous keratopathy (1), and ocular cicatricial pemphigoid (OCP) (1). A contact lens was used in all but one eye. All eyes presented with vitritis and decreased vision, five eyes were painful, and conjunctival injection was documented in six eyes. Average time to presentation and diagnosis with endophthalmitis after K-Pro was 9.7 months (range 2 to 25 months). For nine of these eyes, a topical fluoroquinolone drop was the sole antibiotic prophylaxis at the time of endophthalmitis. Vitreous cultures were obtained in nine eyes and were positive for coagulase negative staphylococci (7 eyes), Providencia rettgeri, a gram negative bacillus (1 eye), and a gram negative unspeciated organism (1 eye). All eyes had documented improvement in vision and symptoms after treatment.Six of the ten eyes presented with and were treated for recurrent endophthalmitis, which was diagnosed as a new occurrence of vitritis and pain and occurred at a mean of 2.3 months following resolution of the initial episode of endophthalmitis. A topical fluoroquinolone drop was the sole antibiotic prophylaxis at the time of recurrent endophthalmitis for five of the six eyes.
Infectious endophthalmitis is more common and presents later than typical postoperative endophthalmitis in eyes receiving Dohlman type I keratoprostheses. Proper selection and use of prophylactic antibiotics may be important in reducing its incidence.
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