Boston Keratoprosthesis-Associated Infections: Prevention and Therapeutics


Author (year)

Location [Ref.]

Study years

B-KPro (I;II) eyes (patients)

Ocular disease AI, CB, GF study Pop

Months mean (range)

BCL

GDD

Prophylactic topical Abx

Endop (total) %

(%) Ster Vit

Organisms cultured

VA loss

USA

Dohlman (1994)

Boston, MA [12]

1990–1993

11 (I-7;II-4)

AI:5,CB:4,GF:2

(9–36)

No

No

Bacitracin-PMB or Vanco

1 (9.1 %)

ND

S. aureus

NLP

Dohlman (1998)

Boston, MA [30]

1990–1996

24 (I-8;II-16)

AI: 24 Autoimmune

5–72

No

20

Oflox or TMP-PMB ×2

4 (5) (20.8 %)

ND

ND

4-NLP 1-LP

Yaghouti (2001)

Boston, MA [17]

1990–1997

63 (I-42;II-21)

53: AI:24,CB:14, GF:15

47 (21–101)

No

NA

Antibiotics rotated

0 (5) (8 %)

ND

ND

ND

Nouri (2001)

Boston, MA; Miami, FL [18]

1990 -Jan 2000

108 I-65;II-43

AI:40,CB:28, GF:40 endophthalmitis

40

No

ND

Oflox/cipro, gent, erythro, TMP-PMB

8 (13) (I:6;II:7) (12 %)

0

S. aureus-3; CNS-2; S. pneumo-3; other strep-5

VA loss 10/13

Dohlman (2002)

Boston, MA [23]

2000–2002

19

AI:1,CB:1,GF:17 Kontur BCL

5.5 (0.5–17)

Yes

No

Oflox/many vanco ×2

1 (14) (5 %)

0

CNS-blebitis

None

Ray (2002)

Boston, MA [31]

1990–2002

22 eyes (110 total)

AI:8,CB:4:GF:4 PPV: 22

ND

ND

ND

ND

5 (NA)

ND

ND

Yes

Nouri (2005)

Boston, MA [25]

1990–2003

218 (I-155;II-63)

AI:2,CB:1,GF:5 Sterile Vitritis: 8

Vitritis (2–23)

4/6

5/8

Oflox/cipro 5/8 vanco/oflox1/8TMP-PMB 2/8

0

8

3/8 CNS only liquid broth

None

Barnes (2007)

Boston, MA [24]

1990–2004

202 < 1999:96; 2000–04:106 (I-148;II54)

4: OCP:2,GF:2 fungal keratitis/Endop

(1–152)

Yes

Yes, +C.p. inf

Vanco + 4FQ

4 (17)

0

1-C.glabrata 2-C.paraps and Alcaligenes sp 3-C.albicans 4-Fusarium

VA loss in 3

Sayegh (2008)

Boston, MA [32]

2000–2005

16 (I:6;II:10)

AI: 16 Stevens-Johnson synd

43.2 (11–67)

Yes

Yes

Vanco + 4FQ

0

1

NA
 
Durand (2009)

Boston, MA [22]

1990–2006

255 1990–99: 96 2000–06:159

AI:7,CB:38, GF:140 bacterial endophthalmitis

31.7

ND

ND

1990–1999: TMP-PMB or FQ; Nov 1999: 4FQ + vanco

7 (24) <1999: 12/96 (12.5 %) <2006: 6/159 (3.8 %)

ND

S.aureus-2; CNS-2; S.pneumo-4; other strep-6; PsA-1 Serratia-1 AtypmycoB-1

CNS: no VA loss

Dohlman (2010)

Boston, MA [33]

2001–2005

31 eyes (34 shunts)

AI:14,CB:7, GF:13

(4–84)

ND

34

Vanco and FQ × 1–2

1 (NA) [22]

0

atypical Mycobact

ND

Rivier (2009); Cade (2011)

Boston, MA [34, 35]

1993–2007; 1990–2010

(1) 18 (2) 28 (23)

AI:4, CB:8, GF:6 1: DLTSC; 2:Chemical Burn

1; 26.6 2: 57 (1–162)

ND

Yes

ND

1 (NA) [25]

ND

Alternaria one wk s/p DLTSC; ND

No VA loss

Aquavella (2005)

Rochester, NY [36, 37]

2003–2005

25

AI:0,CB:0,GF:25 Adults:24; Pedi:1

8.5 (2–24)

All

4

Vanco + levo × 2

0

2 8 %

NA

NA

Aquavella, Akpek (2007)

Rochest, NY Baltimore MD [38]

2004–2007

21

Pediatric GF: 21 Peter’s anomaly; glaucoma

9.7 (1–30)

All

NR

Vanco + levo × 2

0

NR

NA

NA

Akpek, (2007)

Baltimore MD Boston,MA Rochest, NY Washing, DC [39]

1999–2006

16

GF: 16 Aniridia adults

17 (2–85)

All

3

Vanco + levo × 2

0

NA

NA

NA

Aquavella, Akpek (2010)

Rochest, NY Baltimore, MD [40]

2004–2007

126

AI:3,CB:4;GF:119 pediatric and adult

NR

All

12

NR

6 (NA)

2 1.6 %

NR

NR

Akpek (2011)

Baltimore, MD [41]

2004–2009

25

AI:4,CB:0,GF:21 aphakic 10; pseudophakic 15

21.9 (12–43); 35.7 (19–61)

Yes

17

NR

1 (NA)

0

NR

NR

Akpek (2011)

Baltimore, MD [42]

2004–2010

66

AI: 6; GF: 60 adults

20.1

Yes

1

FQ only; AI/Dry Eye: FQ + vanco ×4; doxy 100 ×2

3 (4.5 %) AI: 3/6

0

1 and 2: Fungal 3: Staph sp.(1 month)

1: NLP 2: HM; 3:20/80

Ramchandran, (2012)

Rochester, NY [43]

2004–2008

141 (130)

AI:1,CB:0,GF: 9

Mean Endop: 9.8 (2–25)

Yes

3 with infect

4FQ −8 pts: x2–4; levo −1 eythro-1

10 (9 Cx+) (7 %)

7

7CNS : 4FQ-R; undiff coccobacilli; P. rettgeri

4/7 lost VA

Zerbe (2006)

Multicenter US Study- [44]

2003–2005

136

AI:6,CB:20,GF:110 17 sites

8.5

Yes

55

Vanco 96; FQ 127; Doxy16; TMP-PMB-2

0

7 5 %

NA
 
Bradley, Mannis (2009)

Sacramento, CA [45]

2004–2008

30

AI:1,CB:3,GF:26

19

All

9

All vanco 50 mg/mL

3 (10 %)

1 3 %

1-PsA 2-P.mirabilis 3-H.influenza

LP

1: Li; 2: Greiner (2011)

Sacramento, CA [46, 47]

2004–2010

40 (35)

AI:2,CB:11,GF:27 25-glaucoma devices

33.6

All

25

1:Vanco 50 mg or 4FQ × 4 2: vanco 50 GDD erosions (58.8 %)

?above2 (NA); 2 (5) (12.5 %)

0

1-PsA: GGD 2MSSA:GGD 3-P. mirabilis 4-H. influenz 5-C.paraps

1: LP 2: HM

1:Fintel-mann 2: Chew (2009)

Philadelphia, PA [48, 49]

2001–2007; 2005–2007

(1) 35 (2) 37 (I-36; II-1)

1-AI:0,CB:0,GF:35 2-AI:3,CB:2,GF:32

1: 5–57 2: 16 (6–28)

All

NR; 31

1:Vanco 25 mg/ml + 4FQ; 2,3,4: 4FQ; noncompliance

4 (11.4 %)

0

1:MSSA FQ-R + PsA FQ-S 2,3:CNS,FQ-R 4-culture neg

1:20/200 2:20/400 3:20/200 4:20/40

Patel (2011)

NY EE NY, NY [50]

2006–2010

58 (51)

AI:3,CB:3,GF:52

21.5 (3–47)

All

26

Vanco 25+/−4FQ noncompliance

1 (1.7 %)

1

S.paucimobilis

NLP

Kiang (2012)

Weill Cornell, NY, NY [51]

NR

14 (13)

CB: endop vitrectomy

NR

NR

Yes

NR

1 (NA)
 
NR; occluded GDD

NR

Kamyar (2012)

Ann Arbor, MI [52]

2003–2009

36 KPros; 30 (29)

AI:0; CB:7, GF:23

17 (3–67)

Yes

14

Vanco 25+ 4FQ ×4, then 4FQ alone

0

0

NA: 3/11 occluded GDD

NA

Chan (2012)

Cincinnati, OH [53]

2004–2010

126 (105)

Endop: 1:GF,2:AI,3:AI

41 (1–71)

All

NR

Vanco + 4FQ noncompliance

3 (2.4 %)

0

1: O.anthropi 2: C. paraps 3: C.albicans

1: LP; 2:20/60; 3: LP

de la Cruz (2009)

Chicago, IL [54, 55]

2007–2009

45

15/45 contact lens surveillance SEM
   
Vanco + 4FQ

1 (2.2 %)
 
BCL: S. pneumoniae

Total VA loss

Kang (2012)

Chicago, Ill [56]

2007 –Mar 2011

21’(19)

Primary penetrating keratoplasty

14.6 (6–36.3)

Yes
 
Vanco + 4FQ

1 (NA)

0 %

CNS
 
Tsui (2010)

Los Angeles CA [57]

2008

Type I

AI: 1 single case

36

Yes

7 year infect

Vanco 25+ 4FQ

1 (NA)

2 prior

Shunt + KPro Nocardia farcinica

20/200 – LP

Aldave (2009)

UCLA Los Angeles, CA [58]

2004–2008

57 KPros 50 eyes

AI:5, CB:5, GF:40

17

Yes

21

Vanco + 4FQ ×4 4–6 mths, 4FQ only ×4

0

(10 %)

Vitritis-CNS – 2 recurr 3 and 4 month; vitritis

None

Aldave (2012)

UCLA, Los Angeles, CA [67]

2006 –July 2011

110 KPros 98 eyes (94)

AI:6, CB:8, GF:80 USA

24.1 (<1–84)
 
58

Vanco + 4FQ; no antifungal prophylaxis

1/94 (1.1 %)

10 (10.6 %)

2009 study CNS with recurrence
 
International

Javadi (2006)

Tehran, Iran [59]

1995–2002

4 (I-2;II-2)

Comparative of keratoprosthesesAI:10,CB:17,GF:2
 
No
 
Sulfacetamide 10 %

4
 
NR

All VA loss

Stolz, (2008)

Porto Alegre, Brazil [60]

NA

14

AI: 2, CB:6, GF:6

11.2 (2–25)

NA

3/14

4FQ ×4

1 (7 %)
 
C. albicans

NLP

Magalhaes (2013)

Sao Paulo, Brazil [61]

2008–2011

31 (31)
 
16.5 (3–29)
  
4FQx1 + 5 % PI monthly

0
 
NA

NA

Georgalas (2010)

Athens, Greece [62]

NR

31

1: CB; 2 and 3: AI three case report
 
Yes

1 and 2

Vanco + oflox ×1

3 (9.7 %)

0

All culture negative

None

Verdejo-Gomez, (2011)

Barcelona, Spain [63]

2006 –

12 (12)

AI: 2, CB: 1, GF: 9 Prospective observ

23 (6–42)

Yes

1

Lomefloxacin +/− vanco ×1-2

0

0

NA

NA

Guell, (2011)

Barcelona, Spain [64]

2006–Mar 2011

54 (53)

AI:3, CB:0, GF:51 retrospective

20.15 (1–56)

Yes

22

Vanco 14 mg + FQ + occas antifungals

0
 
NA
 
Bajracharya; Tabin (2012)

US to Kathmandu, Nepal [65]

2008

Type I

GF: 1 single case report

29

Yes

None

Cipro 0.3 %-dex 0.1 %

0
   
Iyer G (2012)

Chennai, India [66]

2008–April 2011

20

AI:0, CB:7, GF: 13 retrospective

21.8 (6–45)

Yes

5

Vanco + 4FQ ×4 6 month, then ×2

0

0

NA

NA

Gevorgyan (2011)

Yerevan, Armenia [79]

2006–2010

18 KPro in 17 eyes (12)

AI:2, CB:11, GF:5

23 (2.4–48)

Yes

NR

NR “limited compliance”

3 (17 %)

2 (11.1 %)
  
Aldave, Others (2012)

11: Armenia, Russia, Indonesia, Nepal, India, Philippines, Saudi Arabia [67]
 
International: 113 B-KPros 107 eyes (100)

AI:15,CB:33,GF:50

14.2 (1–48)

97 %

20

Vanco + 4FQ; no antifungal prophylaxis

9/101 eyes (8.9 %)

4 (4.0 %)

Only 5/9 vitreous tap: Candida sp; 2: others; 3: no growth
 
Robert (2013)

Montreal, Canada [68]

2008–2009

37 (37)

AI:2, CB:3,GF:32 Prosp corneas: fresh(19), frozen (18), autograft (1)

Fresh: 10.7 frozen: 8.6

Yes

NR

4FQ × 4

0

7
  
Robert (2012)

Montreal, CA [28]

2010

Not described

Single case report

ND

No

NR

4FQ only

1

NA

CNS: moxiS; levoR, erythroR

20/30 - > 20/300


Literature reports were grouped by location, by B-KPro surgeon(s), and chronological order. The new and total endophthalmitis cases are noted to avoid duplicate reporting

Endop endophthalmitis, ster vit sterile vitritis, neg negative

AI autoimmune including SJS (Stevens-Johnson syndrome) or OCP (ocular cicatricial pemphigoid), CB chemical burn including alkaline, acid, and thermal burns, GF graft failure or other non-autoimmune, non-burn patients, BCL bandage contact lens, GDD glaucoma drainage device, PPV pars plana vitrectomy, DLTSC diode laser transscleral cytophotocoagulation, NR not reported, NA non-applicable, V A visual acuity, CF counting fingers, HM hand motion, LP light perception, NLP no light perception, ABx antibiotics, vanco vancomycin, FQ undesignated fluoroquinolone, 4FQ fourth-generation fluoroquinolone (moxifloxacin or gatifloxacin), oflox ofloxacin, levo levofloxacin, cipro ciprofloxacin, moxiFQ moxifloxacin, doxy doxycycline, clinda clindamycin, erythro erythromycin, gent gentamicin, TMP/PMB trimethoprim-polymyxin B (Polytrim), Frequency As an example, drug × 2: two times per day

S. aureus Staphylococcus aureus, CNS coagulase-negative staphylococci species defined as a group of ten closely related species, S. pneumo Streptococcus pneumoniae, other strep streptococci including Group A, Group B, viridans streptococci, PsA Pseudomonas aeruginosa, H. influenz: Haemophilus influenzae, P. mirabilis: Proteus mirabilis, S. paucimobilis: Sphingomonas paucimobilis, O. anthropi: Ochrobactrum anthropi, C. paraps: Candida parasilopsis, C. glabrata: Candida glabrata, AtypmycoB atypical mycobacteria, Capital S designation reflects antibiotic susceptible, capital R designation reflects antibiotic resistance. MSSA methicillin-sensitive S. aureus, MRSA methicillin-resistant S. aureus, MRSE methicillin-resistant coagulase-negative staphylococci, FQ-R fluoroquinolone resistance, Cp-R ciprofloxacin resistant, Em-R erythromycin resistant

Cx neg culture negative, Cx+ culture positive




Table 18.2
Details of single surgeon experience




















































No. [Ref]

Diagnosis
Surgery year
GDD
Conj Flap BCL
Time to Inf (month)
Antibiotic prophylaxis
Organism
Susceptibility; other micro, etc.
Time to Tx distance
Pre-Op VA

Best VA

Post-endop VA

1 [12, 18, 22, 30]
OCP
1990
No
Conj Flap
9
Gent × 2 ? noncompliance
S. aureus

Pan-Sens
2 days
HM 4′
20/40
NLP

2 [18, 22, 30]
SJS
1994
No
Conj Flap

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  4. Boston KPro Type I: Vitreoretinal Considerations

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Mar 20, 2017 | Posted by in OPHTHALMOLOGY | Comments Off on Boston Keratoprosthesis-Associated Infections: Prevention and Therapeutics

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