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Introduction
The Boston keratoprothesis type I (KPro) is gaining recognition as an excellent alternative for patients with severe corneal disease and poor probability of success with traditional penetrating keratoplasty. The KPro design, the procedure itself, and the postoperative management of patients continue to evolve. 1-3 Such advances have improved outcomes for these patients and thus, allowed the indications for KPro surgery to expand.
While a KPro readily allows for restoration of visual axis clarity, complications following surgery can compromise the initial improvement of visual acuity (VA). In recent case series, glaucoma was shown to be the most prevalent vision-threatening complication. 4 5 However, the most severe and feared complication remains endophthalmitis as this can be both sight and globe-threatening. While the incidence of postoperative endophthalmitis was tremendously reduced after the implantation of routine prophylactic antibiotics post-KPro surgery, new cases are still emerging. 6
The purpose of this review is to summarise the current knowledge on endophthalmitis in patients with a Boston KPro. We will critically evaluate the literature on this subject to determine what future studies are needed to improve patient outcomes. In addition, a new case of endophthalmitis will be reported.
Materials and methods
A review of the literature from January 2001 to September 2011 was performed using Pubmed and the search term 'Boston Keratoprosthesis'. Cases of endophthalmitis following KPro surgery were identified by review of the title and abstracts of the search results. Twelve retrospective case series and two case reports were identified. The average prevalence of endophthalmitis was calculated using pooled data. Studies were grouped by the year of publication to calculate yearly rates. We present an additional case of endophthalmitis in a patient with Stevens Johnson syndrome.
Results
Review of the literature
Definition of endophthalmitis
Endophthalmitis is an infectious inflammatory reaction affecting the anterior and posterior segments of the eye. 7 Its aetiology can be exogenous or endogenous. Exogenous endophthalmitis results when an external pathogen is introduced directly into the eye by either surgery or trauma. Endogenous endophthalmitis results from the haematogenous spread of infectious organisms from a distant site. The most common form of endophthalmitis is postoperative exogenous endophthalmitis, and accounts for 55-70% of cases. 8-10 There is a risk of contracting endophthalmitis after any type of surgical procedure,...