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Rosalind C Vo, Jamie K Alexander, Anthony J Aldave; Sterile Vitritis after Keratoprosthesis Implantation: Incidence, Management, and Outcomes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2835.
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© ARVO (1962-2015); The Authors (2016-present)
To report the incidence, presentation, treatment, and outcomes of sterile vitritis following implantation of the Boston type 1 Keratoprosthesis (KPro).
A retrospective chart review was conducted of 160 consecutive Kpros implanted over a 9-year period by a single surgeon.
Sterile vitritis developed following implantation of 16 of the 160 Kpros in 16 eyes of 15 patients. The average time to onset of vitritis after KPro implantation was 12.4 months (range, 1- 33 months). Associated clinical features included significantly reduced vision (counting fingers to light perception in most cases) but minimal to no ocular pain and minimal conjunctival injection. An anterior chamber reaction and dense vitritis were present in all eyes. A corneal infiltrate was present at the time of vitritis diagnosis in 3 cases. Vitreous tap, intravitreal antibiotic and steroid injection were performed in 12 cases; pars plana vitrectomy was also performed in 2 of these cases. All cultures were negative except for one eye, in which repeat cultures were negative. Three cases were treated with topical steroid and antibiotic therapy alone, and one case was treated with a sub-Tenon injection of triamcinolone. The vitritis resolved at a mean of 36.5 days (range, 3- 47 days), although the vitritis recurred in 5 eyes. Nine eyes developed retroprosthetic membranes shortly after the vitritis episode, necessitating membranotomy, although the CDVA returned to the pre-vitritis level in 11 eyes. The CDVA was decreased in the remaining eyes secondary to dense retroprosthetic membrane, stromal necrosis, choroidal detachment, retinal detachment and cystoid macular edema.
Sterile vitritis occurs in 10% of eyes after implantation of the Boston Type 1 keratoprosthesis. As the clinical features overlap with those of infectious endophthalmitis, cases should be presumed to be infectious and treated as such. As sterile vitritis results in permanent decrease in CDVA in approximately 1/3 of cases, additional investigations into the causes and potential preventative measures are indicated.
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