Characteristics of Endophthalmitis in Patients With the Boston Keratoprosthesis
Characteristics of Endophthalmitis in Patients With the Boston Keratoprosthesis
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DOI：
10.1097/ico.0b013e31819b0385
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发表时间：
2009-09-01
期刊：
影响因子：
2.8
通讯作者：
Ayres, Brandon D.
中科院分区：
文献类型：
--
作者：
Fintelmann, Robert E.;Maguire, Joseph I.;Ayres, Brandon D.
目的：确定波士顿人工角膜患者眼内炎的特征。方法：对 2001 年至 2007 年间在 Wills Eye Cornea 服务中接受波士顿人工角膜移植并出现感染性眼内炎的 35 名患者中的 4 名患者进行回顾性图表审查。结果：所有 4 名患者均因之前角膜移植失败而接受了人工角膜手术。眼内炎的发生率为11.4%。所有患者均使用氟喹诺酮类药物进行局部抗生素预防，4 名患者中的我还使用万古霉素滴剂。所有 4 名患者均接受了穿刺和注射，并入院接受为期 3 至 7 天的强化静脉注射和局部抗生素治疗。 4 个玻璃体样本中的 3 个发现培养阳性结果：2 个凝固酶阴性葡萄球菌，1 个假单胞菌和金黄色葡萄球菌。最低抑菌浓度数据显示所有分离株对第四代氟喹诺酮类抗生素具有高耐药性。所有患者均恢复了显着的视力，除了 I 例患者因玻璃体视网膜牵引带继发视力波动，该视力波动继发于眼内炎。结论：波士顿角膜假体术后发生眼内炎的几率很高，即使是在预防性滴用抗生素的低风险患者中也是如此。鉴于我们对这些患者和万古霉素的治疗经验，我们建议预防性使用。本报告进一步支持革兰氏阳性菌对氟喹诺酮类药物的耐药性不断增加，以及需要密切患者随访以鼓励遵守预防方案。
Purpose: To determine the characteristics of endophthalmitis in patients with the Boston keratoprosthesis.Methods: Retrospective chart review of 4 out of 35 patients who underwent implantation of the Boston keratoprosthesis on the Wills Eye Cornea service between 2001 and 2007 and developed infectious endophthalmitis.Results: All 4 patients had keratoprosthesis surgery due to previous corneal transplant failure. The incidence of endophthalmitis was 11.4%. All patients were on topical antibiotic prophylaxis with a fluoroquinolone and I of the 4 patients was also using vancomycin drops. All 4 patients underwent a tap and inject and were admitted for intensive intravenous and topical antibiotics for 3 to 7 days. Culture positive results were found in 3 of the 4 vitreous samples: 2 coagulase-negative Staphylococcus, and I Pseudomonas and Staphylococcus aureus. Minimum Inhibitory Concentration data showed high resistance to fourth-generation fluoroquinolone antibiotics in all isolates. All patients recovered significant vision, except I patient who developed fluctuating vision secondary to vitreoretinal traction bands, which developed secondary to the endophthalmitis.Conclusion: Endophthalmitis can occur after Boston keratoprosthesis at a significant rate, even in low-risk patients on prophylactic antibiotic drops. Given our experience with these patients and vancomycin, we recommend its prophylactic use. The increasing resistance of gram-positive organisms to fluoroquinolones and the need for close patient follow-Lip to encourage adherence to preventive regimens are further supported in this report.