Incidence and Microbiology of Endophthalmitis in Eyes With a Type 1 Boston Keratoprosthesis: A Systematic Review and Meta-Analysis.
David M Morcos, Thomas H Dohlman, Marlene L Durand
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In 30 seconds
This systematic review and meta-analysis assessed endophthalmitis incidence and microbiology in eyes with a type 1 Boston Keratoprosthesis (BKPro). Of 501 studies screened, 34 met inclusion criteria and included 2732 eyes; mean follow-up was under 5 years in 85% of studies. Across the included literature, 161 eyes developed endophthalmitis. The pooled mean incidence was 2.09 cases per 100 eye-years (95% CI, 1.63-2.67). Among 44 cases with complete microbiology, bacterial infections predominated, followed by fungal infections and cases with no growth.
Key findings
- The pooled mean incidence was 2.09 cases per 100 eye-years (95% CI, 1.63-2.67).
- Of 44 cases with complete microbiology, 54.5% were bacterial, 29.5% fungal, and 16% had no growth.
- Two thirds of bacterial cases involved gram-positive bacteria; fungal cases were primarily Candida.
- Reported risk factors included antecedent keratitis, prophylactic-antibiotic noncompliance, corneal melt around the BKPro, and an exposed glaucoma drainage device.
Why it matters
Endophthalmitis is a serious complication in BKPro eyes, and this pooled estimate provides an incidence measure across recent studies rather than relying only on the proportion of patients affected. The microbiology and reported risk factors also describe the range of organisms and clinical circumstances associated with cases, while underscoring that infections may occur despite topical antibiotics effective against the pathogen.
What to keep in mind
Follow-up was relatively short: it was under 5 years in 85% of studies. The authors note that longer follow-up is needed to determine 5- and 10-year risk.