Corneal Implant Patients With Stronger Preoperative Acuity Recover From Infection Better

Ophthalmology, Woman
3 in 1 ophthalmic device : automatic refractometer, automatic keratometer and corneal topography. (Photo by: BSIP/Universal Images Group via Getty Images)
A study shows visual acuity 6 months after endophthalmitis following keratoprosthesis implantation correlates with pre-endophthalmitis acuity.

For patients who developed endophthalmitis following a Boston keratoprosthesis (KPro) implantation, visual acuity (VA) at 6 months correlates with their VA pre-endophthalmitis, according to findings published in Retina.

Patients (N=137) who received a KPro type 1 or 2 implant at the Duke Eye Center between 2009 and 2020 were retrospectively assessed for endophthalmitis and VA outcomes.

Total of 7 eyes (5%) developed endophthalmitis after receiving a KPro type 1 (n=5) or type 2 (n=2) implant. The participants all had endophthalmitis, had a mean age of 59±13 years and 5 were men. All had corneal failure after a previous cornea surgery.

At the time of implantation, 4 eyes were aphakic and 3 were pseudophakic. During the procedure, 2 eyes also underwent Baerveldt tube shunt placement and 1 eye a Baerveldt tube shunt placement with pars plana vitrectomy.

The average time from implantation to endophthalmitis was 34±27 months, at which time all but 1 patient had subjective decreased vision, 3 had irritation, 1 photophobia, and 1 had ocular pain. Patients were prescribed polymyxin B sulfate and trimethoprim (n=5), moxifloxacin (n=1), or ciprofloxacin (n=1). All eyes received vancomycin with either ceftazidime (n=5) or amikacin (n=2). In addition, 3 eyes were given an antifungal injection.

The causative organisms Streptococcus intermedius and Mycobacterium abscessus were cultured from 1 eye each.

The KPro implant was removed between 1 and 242 days from 4 eyes and was replaced in 3 eyes.

Prior to endophthalmitis, mean VA was 20/267 which deteriorated to 20/5944 at endophthalmitis presentation. On average, VA improved to 20/1059 at 3 months and 20/734 at 6 months. Improvement was not achieved by 2 eyes. The investigators observed a correlation between pre-endophthalmitis VA and VA at 6 months (r, 0.92; P =.003).

These data may not be generalizable, as the patient population had extensive histories of prior surgical failures.

The study authors concluded that pre-endophthalmitis VA was predictive of post-endophthalmitis VA among patients who received KPro implants.


Lee T, Robbins CB, Wisely E, Grewal DS, Daluvoy MB, Fekrat S. Clinical characteristics and visual outcomes in endophthalmitis after keratoprosthesis Implantation. Retina. Published online September 2, 2021. doi:10.1097/IAE.0000000000003300