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M. Nouri, C.H. Dohlman; Sudden Vitritis-Presumed Sterile-in Patients With Keratoprosthesis . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2396.
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Purpose: To report a phenomenon of presumed sterile vitritis associated with a PMMA keratoprosthesis (KPro). Methods: Between 1999 and 2002, 76 patients had undergone an all-PMMA, collarbutton-shaped KPro surgery. Preoperative diagnoses were multiple graft failures, chemical or thermal burns, ocular cicatricial pemphigoid, and Stevens-Johnson syndrome. One patient had a past history of herpes simplex keratouveitis, and was kept on acyclovir. All patients were maintained on prophylactic topical ofloxacin 0.3% or polymyxin-B/trimethoprim, as well as prednisolone acetate 1%, at least twice daily. Vancomycin (14mg/ml) was also given twice daily in some patients. Results: The vitritis occurred in six patients 54 to 271 days postoperatively. All patients presented with sudden, marked decrease in vision without pain, tenderness or increased redness or discharge. All patients underwent vitreous tap and injection of antibiotic and steroids on the day of presentation. There were no organisms isolated. The vitritis episode had resolved after one to two months. Full recovery to pre-episode status with clear vitreous was seen in all patients. Visual acuity recovered completely (mental debilitation in one patient made accurate assessment uncertain). No recurrence of inflammation was seen with steroid taper. To date the patients have suffered only one such episode. Conclusions: This phenomenon of sudden vitritis after KPro, with few other symptoms, no organisms found and with complete recovery, is very unlikely to have been caused by microorganisms. Rather it may be an immune phenomenon.
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