Culture-proven endophthalmitis associated with Boston Type I keratoprosthesis: clinical features, microbiologic aspects, and outcomes

PURPOSE: To characterize the clinical presentation, management, and outcomes of culture-proven endophthalmitis associated with the surgical use of a Boston Type I keratoprosthesis (Boston I KPro). METHODS: A retrospective consecutive case series was conducted of culture-positive cases of endophthalmitis associated with the surgical use of Boston I KPro at a single tertiary referral center. Data were collected on patient demographics, transplant history, presenting features, management strategies, and outcomes. RESULTS: Inclusion criteria were met by 9 eyes of 9 patients. The mean age was 76 ± 3 years. At presentation, all eyes were on chronic topical antibiotic prophylaxis. Initial vision was hand motion or worse in 8/9 (89%) of eyes. Presumed etiologies included early postoperative infection in 3/10 (30%), corneal melt with leaks in 3/10 (30%), corneal ulcer without leaks in 3/10 (30%). Vitreous cultures identified gram-positive organisms in 7/9 (78%), including Staphylococcus aureus in 3, Streptococcus sp. in 3, coagulative-negative Staphylococcus in 1, Corynebacterium in 1 and Mycobacterium in 1. Vitrectomy was performed in 8/9 (89%) of eyes with 3 eyes undergoing removal of the Boston I KPro. Despite prompt treatment, visual outcomes were poor with best-corrected visual acuity at last follow-up averaging 20/1600 with 2 eyes achieving ≥ 20/200 vision. Enucleation or evisceration was performed in 2 eyes. CONCLUSIONS: Culture-proven endophthalmitis after Boston I KPro implantation is a rare, devastating complication. Patients present rapidly with severe vision loss. Management often includes prompt vitrectomy. Visual prognosis is guarded with most eyes having worse than 20/200 vision at last follow-up.