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    Managing infections in artificial cornea

    Contemporary prevention, management may allay cases of keratitis, endophthalmitis

     

    Infectious endophthalmitis

    Infectious endophthalmitis occurs in up to 12.5% of patients who are implanted with the device, despite using prophylactic antibiotics postoperatively. Gram-positive organisms are mostly responsible for the endophthalmitis.

    Learn More: Visit the Cornea homepage

    However, Dr. Colby noted that recently surgeons are seeing an uptick in gram-negative and fungal infections. The management in these patients is the standard tap and inject and physicians can consider a pars plana vitrectomy.

    The endophthalmitis risk factors include patient non-compliance with antibiotic therapy.

    “It is very important to underscore the importance of instilling the antibiotics in patients implanted with KPro,” she said.

    Antibiotic Resistance: Visit the homepage for more articles

    As with infectious keratitis, risk factors include Stevens-Johnson syndrome, mucous membrane pemphigoid, and infectious keratitis itself.

    “Early diagnosis and management of infectious keratitis will decrease the chance of progression to endophthalmitis,” Dr. Colby said.

    Conjunctival erosion has also been reported as a risk factor for endophthalmitis.

    Recent: What physicians need to know about bacterial resistance

    A pitfall in these patients is the difficulty in differentiating idiopathic vitritis, which can develop in up to 14.5% of patients, from infectious endophthalmitis. The vision in patients with vitritis can decrease acutely. The clue to the diagnosis is that the eye is “quiet” and painless, and administration of topical steroids or a sub-Tenon’s depot injection results in rapid visual improvement.

    Dr. Colby advised seeing patients a few days after steroid treatment to determine if the vision has improved.

    When in doubt

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