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Postop infections reduced with additional prophylaxis after KPro implantation
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CHICAGO — Adding povidone-iodine and amphotericin B as prophylaxis after Boston type 1 keratoprosthesis implantation significantly reduced the rate of postoperative infections, according to a speaker at the American Academy of Ophthalmology meeting.
After successfully reducing the incidence of bacterial infections after KPro implantation using povidone-iodine 5% antibacterial drops, Jeffrey D. Welder, MD, said he and colleagues at the University of Iowa instituted a regimen of povidone-iodine plus topical amphotericin B four times daily for 1 week after contact lens change in patients implanted with the KPro.
Welder and colleagues retrospectively reviewed 79 eyes that received vancomycin and a fluoroquinolone (group 1), additional povidone-iodine (group 2), or additional povidone-iodine and amphotericin B (group 3). Patients were followed for 1 year, totaling more than 91 years of follow-up in group 1, 44 years in group 2 and 77 years in group 3.
“The purpose of our study was to compare the incidence of postoperative infection in those treated with just topical antibacterials vs. those treated with povidone-iodine plus or minus the amphotericin B,” Welder said.
Even though corneal edema is the most common indication for KPro, there were no infectious complications in those cases, Welder said. Infections occurred most often in patients who received the implant for herpes simplex virus or trauma.
There were seven cases of microbial keratitis and 10 cases of endophthalmitis, resulting in an infection rate of 17.7%, according to Welder.
Group 1 had a predominance of bacterial infections, group 2 had a decrease in infections, of which 50% were fungal, and group 3 had no culture-positive infections.
The povidone-iodine plus amphotericin B group yielded one culture-negative case of keratitis compared with four cases of keratitis and eight cases of endophthalmitis in the vancomycin and fluoroquinolone group.
“We found that overall there was a significant decrease in the incidence of infection between group 1 and group 3. Microbial keratitis had a fourfold decrease. It did not reach any statistical significance, but we have not had a case of microbial keratitis after KPro at the university since November 2012 and endophthalmitis was basically completely eliminated,” Welder said.
According to Welder, group 1 had four cases of microbial keratitis (two bacterial two fungal) and eight cases of endophthalmitis. Group 2 had two bacterial and two fungal infections, plus two cases of microbial keratitis and two cases of endophthalmitis. Group 3 had only one culture-negative case of microbial keratitis.
KPro loss occurred in 35% of eyes with postoperative infections. KPro extrusion occurred in six of 14 eyes with infections but did not occur in any eye that did not have infection, Welder said.
“This [study] at least suggests the role of povidone-iodine and amphotericin B, and we are really excited to see future research,” he said.
Welder acknowledged that there was limited follow-up in the povidone-iodine group. – by Nhu Te