Infectious Keratitis After Boston Type 1 Keratoprosthesis Implantation
Infectious Keratitis After Boston Type 1 Keratoprosthesis Implantation
复制标题
DOI：
10.1097/ico.0b013e318245c02a
复制
发表时间：
2012-10-01
期刊：
影响因子：
2.8
通讯作者：
Holland, Edward J.
中科院分区：
文献类型：
--
作者：
Chan, Clara C.;Holland, Edward J.
目的：确定Boston 1型人工角膜（Kpro）植入后感染性角膜炎的发病率、临床特征和结局。在对105例患者的回顾性病历分析中，确定了10例感染性角膜炎2004年11月至2010年11月在辛辛那提眼科研究所接受Kpro治疗并随访至少1个月的患者（126只眼）结果：本组发生率为7.9%。患者诊断包括4例化学损伤、3例Stevens-Johnson综合征、2例眼瘢痕性类天疱疮和1例先天性无虹膜。2例眼表失败和8例穿透性角膜移植术失败的患者接受了Kpro植入。4例患者为接触透镜不耐受或不依从。所有患者均接受局部万古霉素和阿氟沙星预防，2例接受局部阿氟沙星预防。3例浸润培养阴性，5例为真菌（3例念珠菌，1例镰刀菌，1例缢缩Dactylaria），2例为细菌（马红球菌和革兰氏阴性球菌）。所有患者均采用局部药物治疗，4例口服抗真菌药物。4例患者行Kpro切除联合治疗性穿透性角膜移植术，1例患者行Kpro置换术。在最终随访时，只有2例患者保留了感染前的最佳视力。感染性角膜炎的危险因素包括诊断为瘢痕性结膜炎（Stevens-Johnson综合征、眼部瘢痕性类天疱疮或化学损伤）和持续性上皮缺损病史（分别为P = 0.0003和0.0142）。接触透镜磨损，万古霉素的使用，和全身免疫抑制的历史（或使用时的感染）没有统计学意义的危险factors.Conclusions：感染性角膜炎后Kpro可能发生，即使患者是万古霉素和第四代氟喹诺酮类药物预防。真菌生物体是一个日益引起关注的原因，我们提出的细节，第一次报告的情况下，眼D。缢痕。我们的管理和预防策略的演变Kpro植入后真菌性角膜炎也进行了描述。
Purpose: To determine the incidence, clinical features, and outcomes of infectious keratitis after Boston type 1 keratoprosthesis (Kpro) implantation.Methods: Ten cases of infectious keratitis were identified in a retrospective chart review of 105 patients (126 eyes) who received Kpro between November 2004 and November 2010 at the Cincinnati Eye Institute and were followed for at least 1 month (range, 1-66 months; mean, 25 months).Results: The incidence was 7.9%. Patient diagnoses included 4 chemical injuries, 3 Stevens-Johnson syndrome, 2 ocular cicatricial pemphigoid, and 1 congenital aniridia. Kpro implantation was indicated in 2 eyes for a failed ocular surface and in 8 for penetrating keratoplasty failure. Four patients were contact lens intolerant or noncompliant. All were on topical vancomycin and moxifloxacin for prophylaxis and 2 were on topical amphotericin for prophylaxis. Three infiltrates were culture negative, 5 were fungal (3 Candida, 1 Fusarium, 1 Dactylaria constricta), and 2 were bacterial (Rhodococcus equi and Gram-negative cocci). All patients were managed with topical agents and 4 were given an oral antifungal agent. Four patients had Kpro removal with therapeutic penetrating keratoplasty and 1 had Kpro replacement. At final follow-up, only 2 patients retained their preinfection best vision. Risk factors for infectious keratitis included a diagnosis of cicatrizing conjunctivitis (Stevens-Johnson syndrome, ocular cicatricial pemphigoid, or chemical injury) and a history of persistent epithelial defect (P = 0.0003 and 0.0142, respectively). Contact lens wear, vancomycin use, and a history of systemic immunosuppression (or use at the time of infection) were not statistically significant risk factors.Conclusions: Infectious keratitis after Kpro can occur even when patients are on vancomycin and a fourth-generation fluoroquinolone for prophylaxis. Fungal organisms are a growing cause for concern, and we present the details of the first reported case of ocular D. constricta. The evolution of our management and prophylaxis strategy for fungal keratitis after Kpro implantation is also described.