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OMIG Main Page | 2005 Abstracts | < Previous | Next > Vancomycin topical prophylaxis in the Boston Keratoprosthesis. Authors: Marlene L. Durand, M.D.1,2, Claes H. Dohlman, M.D.1 Affiliations: Massachusetts Eye & Ear Infirmary (1) and Massachusetts General Hospital (2), Boston, MA Purpose: Determine the effect of vancomycin prophylaxis on the incidence of bacterial endophthalmitis in Boston Keratoprosthesis (KPro) eyes. Methods: A retrospective chart review of 187 patients (207 eyes) who received a Boston KPro between March 1990 and January 2005 was performed. All but 5 eyes had a KPro in place for at least 1 month (mean 2.7 years, range 10 days - 13 years). Nearly all patients used chronic topical antibiotic prophylaxis in the KPro eye. Prior to November 1999, this prophylactic regimen was topical polymyxin-trimethoprim, ciprofloxacin or ofloxacin, but beginning late 1999, vancomycin was added to a quinolone (usually ofloxacin) regimen for many eyes. Results: The incidence of bacterial endophthalmitis in patients receiving vancomycin prophylaxis was 1 infection in 225.4 patient-years follow-up (0.0044 infections per patient-year). The incidence was 10 times higher in the non- vancomycin group: 16 infections in 338.8 patient-years follow-up (0.047 infections per patient-year). In the non-vancomycin group, 15 of the infections occurred 6 weeks or more postoperatively (range 1.5 to 46 mos.), and 14 (88%) of the 16 infections were due to gram-positive cocci (Staphylococcus aureus, S. epidermidis, Streptococcus pneumoniae, viridans streptococci). The case of endophthalmitis in the vancomycin group was due to an atypical mycobacterium (Mycobacterium abscessus) and had an indolent presentation beginning 34 mos. postoperatively. Conclusion: A topical antibiotic regimen that contains vancomycin plus a quinolone is effective in preventing acute bacterial endophthalmitis in patients with the Boston keratoprosthesis. Commercial finanacial support: none Commercial Financial Support: None OMIG Main Page | 2005 Abstracts | < Previous | Next >
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