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    Managing infections in artificial cornea

    Contemporary prevention, management may allay cases of keratitis, endophthalmitis

    ChicagoCorneal specialists have turned to a keratoprosthesis (Boston keratoprothesis [KPro], Massachusetts Eye and Ear) with increasing frequency over the past decade to address corneal blindness.

    Kathryn Colby, MD, PhD, attributes the increase in implantations to changes in the postoperative management—and in the device itself, which has been in use since the 1960s—for the decrease in device extrusion and endophthalmitis. Currently, about 11,000 devices have been implanted.

    Related: Femto-CKT procedure shows promise for keratoconus stabilization

    However, infectious keratitis and endophthalmitis may still develop in up to 18% of cases for several factors, she explained.

    “The device is a foreign body without biointegration into the eye that connects the outside world to the interior of the eye,” said Dr. Colby, who is the Louis Block professor and chairman, Department of Ophthalmology and Visual Science, University of Chicago.

    Courtesy of Kathryn Colby, MD, PhD

    “Second, use of low-dose topical antibiotics and topical steroids in the setting of continuous bandage lens wear predisposes the eye to infection,” she added. “Finally, many of these patients have severe ocular surface disease that has been shown to be risk factors for infections.”

    Related: Expert tips for surgically managing corneal perforations

    Infections associated with its implantation can be bacterial or fungal and the risk factors are persistent epithelial defects, a history of autoimmune ocular surface diseases, i.e., Stevens-Johnson syndrome and mucous membrane pemphigoid, and chemical injury.

    Infectious keratitis

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