Infectious Keratitis After Boston Type 1 Keratoprosthesis Implantation

Chan, Clara C.; Holland, Edward J.

doi:10.1097/ico.0b013e318245c02a

Cited by 68 publications

(52 citation statements)

References 23 publications

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“…But the common factor was the symptom of pain in all cases compared to only 25 % patients complaining pain in post-cataract surgery endophthalmitis in the endophthalmitis vitrectomy (EVS) study [7]. The incidence of endophthalmitis at 11.1 % in our study was between other reported incidences in literature (11.4 % and 12 [5,6]-2.5 % and 2.4 % [3,5,6,8,9]), but 158-fold higher than the incidence of endophthalmitis after cataract surgery in our institute (0.07 % culture proven endophthalmitis [10]) and 55-fold higher than penetrating keratoplasty (0.2 %). Other differences included equal distribution of bacterial and fungal infection; but this cannot be concluded emphatically due to small numbers (Table 2).…”

Section: Discussionsupporting

confidence: 63%

Erratum to: Endophthalmitis in Boston keratoprosthesis: case series and review of literature

et al. 2015

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To report the clinical and microbiological characteristics of infectious endophthalmitis after Boston type I keratoprosthesis (B-K-Pro) implantation. Retrospective analysis of 45 eyes that received a B-K-Pro type 1 between 2009 and 2012 was performed. Five eyes with a diagnosis of exogenous endophthalmitis after B-K-pro type 1 were identified and information about demographic data, indication for K-Pro, post-operative bandage contact lens use, post-operative prophylactic antibiotic use, timing and clinical presentation of endophthalmitis, gram stain and culture results of intraocular fluid and preoperative and post-operative visual acuity were collected. The incidence of endophthalmitis was 11.1 % (5 of 45 eyes) and average time to develop endophthalmitis was 5.62 months (range 2 days to 8 months). Mean patient age was 31.4 years (5 to 65 years). The surgical indications included corneal injury due to chemical burns (n = 2), multiple failed grafts secondary to microbial keratitis (n = 2) and congenital glaucoma with congenital herpetic keratitis (n = 1). Post-Boston K-Pro, the visual acuity ranged from light perception (LP) to 20/50. K-pro was explanted in 4 patients. There was bacterial and fungal growth in two patients each and one vitreous did not grow anything. All the eyes were phthisical at last visit. Infectious endophthalmitis after K-Pro implantation in our study had a higher incidence, early onset and extremely poor visual outcome compared with post-cataract surgery endophthalmitis, as reported in literature. Not only bacterial but also fungal infections are an important etiology for infectious endophthalmitis in these cases.

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Section: Discussionsupporting

confidence: 63%

Erratum to: Endophthalmitis in Boston keratoprosthesis: case series and review of literature

et al. 2015

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“…This was possibly due to the biodegradation or dysfunction of SESB2V peptide in the corneal stroma. Our results are encouraging for the early postoperative period, but bacterial endophthalmitis may occur months or years after the placement of a device (4)(5)(6). Hence, future work should examine the role of AMPs combined with a controlled drug delivery system, e.g., nanoparticles or biodegradable films.…”

Section: Discussionmentioning

confidence: 97%

“…Devices that penetrate the skin or those that are within tissues, e.g., the cornea, present the highest risks for infection (2,3). Endophthalmitis, a severe panocular infection, remains one of the most devastating complications after the implantation of any artificial corneal device, e.g., intracorneal stromal rings to correct refractive errors (4,5), Boston keratoprosthesis (6)(7)(8), and osteo-odonto keratoprosthesis (OOKP) (9, 10) used to restore vision in patients with end-stage corneal blindness. Patients with endophthalmitis present with discharge, lid swelling, pain, reduced vision acuity, implant erosion, or exposure (11).…”

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confidence: 99%

Effectiveness of Antimicrobial Peptide Immobilization for Preventing Perioperative Cornea Implant-Associated Bacterial Infection

Tan

Goh

Saraswathi

et al. 2014

Antimicrob Agents Chemother

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Titanium (Ti) is a promising candidate biomaterial for an artificial corneal skirt. Antimicrobial peptide (AMP) immobilization may improve the bactericidal effect of the Ti substrate. In this study, we tested the bactericidal efficacy of a functionalized Ti surface in a rabbit keratitis model. A corneal stromal pocket was created by a femtosecond laser. The Ti films were then inserted into the pocket, and Staphylococcus aureus or Pseudomonas aeruginosa was inoculated into the pocket above the implant films. The corneas with Ti-AMP implants were compared with the corneas implanted with unprotected Ti by slit lamp observation and anterior segment optical coherence tomography (AS-OCT). Inflammatory responses were evaluated by bacterium counting, hematoxylin-eosin staining, and immunostaining. There was a lower incidence and a lesser extent of infection on rabbit corneas with Ti-AMP implants than on those with unprotected Ti implants. The bactericidal effect of AMP against S. aureus was comparable to that of postoperative prophylactic antibiotic treatment; hence, SESB2V AMP bound to the Ti implant provided functional activity in vivo, but its efficacy was greater against S. aureus than against P. aeruginosa. This work suggests that SESB2V AMP can be successfully functionalized in a rabbit keratitis model to prevent perioperative corneal infection.

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“…Ezek közül két esetben Rhodococcus equi okozta a fertőzést. A beül-tetés után elhúzódó lokális profilaktikus vancomycin-és moxifloxacinkezelést javasolnak, azonban, ha fertőzéses szövődményt észlelnek, felmerül a keratoprotézis eltávo-lítása vagy cseréje [4].…”

Section: Megbeszélésunclassified

“…A HIV terjedésétől kezdve egyre gyakrabban diagnosztizálták, legtöbb esetben immunhiányos állapotban lévő betegeken, például szervtranszplantáltaknál és daganatos betegeknél [3]. Gyó-gyászatban használt implantátumokkal összefüggésben csak kevés publikáció született [4,5]. Mozgásszervrend-szeri sebészetben használt implantátumhoz társuló fertőzésről pedig, tudomásunk szerint, eddig még nem szá-moltak be.…”

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Rhodococcus equi által okozott nagyízületi endoprotézis körül kialakult fertőzés

Sallai

Péterfy

Sanatkhani³

et al. 2017

Orvosi Hetilap

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A Rhodococcus equi ritka patogén, amely főként gyengült immunrendszerű vagy immunszupprimált betegekben okoz fertőzést. Esetbemutatásunkban Rhodococcus equi által okozott nagyízületi endoprotézis körül kialakult fertőzést mutatunk be, amelynek leírására még nem volt példa a nemzetközi irodalomban. A 88 éves férfi beteget láz és jobb oldali csípőfájdalom miatt vettük fel klinikánkra. A beteg anamnézisében több, mindkét oldalt érintő csípőműtét szerepelt, és a jobb oldalon aszeptikus lazulás miatt korábban revíziós arthroplastica is történt. Ismert betegségei között szerepelt cukorbetegség, diabeteses nephropathia, valamint korábbi stroke miatt bal oldali hemiplegia, azonban kifejezett immunszuppresszió nem. A képalkotó vizsgálatok a jobb oldali csípőprotézis komponenseit stabilnak mutatták, az ízületi punkcióból pedig Rhodococcus equi tenyészett ki. A betegnek azonnali feltárást és a protézis kö-rüli terület tisztítását javasoltuk, amit visszautasított. Konzervatív kezelést, parenteralis antibiotikum-terápiát kezdtünk. A beteg gyulladásos paraméterei csökkentek, fájdalma megszűnt. Esettanulmányunk célja, hogy a nagyízületi protézisek szeptikus komplikációi kapcsán felhívjuk a figyelmet a ritka patogének növekvő szerepére. Orv Hetil. 2017; 158(27): 1071-1074. Kulcsszavak: Rhodococcus equi, periprotetikus fertőzés, ritka kórokozó Periprosthetic joint infection caused by Rhodococcus equi Case reportRhodococcus equi is a rare pathogen in humans causing infections mostly in immunocompromised hosts. We present the first case of periprosthetic joint infection caused by Rhodococcus equi. An 88-year-old male patient was referred to our clinic with a history of fever and right hip pain. The patient had multiple hip surgeries including total joint arthroplasty and revision for aseptic loosening on the right side. He was immunocompetent, but his additional medical history was remarkable for diabetes mellitus, diabetic nephropathy and stroke with hemiplegia resulting in immobilization. Radiography showed stable components, joint aspirate yielded Rhodococcus equi. Irrigation and debridement was proposed, but the patient refused any surgical intervention. Therefore antibiotic therapy was administered. At the last follow-up the patient is free of complaints but the C-reactive protein level is still elevated. This case illustrates the possible role of Rhodococcus equi in medical device-associated infections.

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Infectious Keratitis After Boston Type 1 Keratoprosthesis Implantation

Cited by 68 publications

References 23 publications

Erratum to: Endophthalmitis in Boston keratoprosthesis: case series and review of literature

Erratum to: Endophthalmitis in Boston keratoprosthesis: case series and review of literature

Effectiveness of Antimicrobial Peptide Immobilization for Preventing Perioperative Cornea Implant-Associated Bacterial Infection

Rhodococcus equi által okozott nagyízületi endoprotézis körül kialakult fertőzés

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