Ocular Microbiology and Immunology Group
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2015 OMIG Abstract 22

Hypochlorous Acid: A Candidate Prophylactic Antifungal Agent for
Boston Keratoprosthesis Patients
Silvia Odorcic, MD, FRCSC, Wolfgang Haas, PhD, Claes H. Dohlman, MD, PhD
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA

Purpose: To review the current literature on fungal keratitis and endophthalmitis following Boston Keratoprosthesis (KPro) implantation, and characterize the antifungal activity of 0.01% hypochlorous acid against fungi known to cause ocular infections. 
Methods: i) A literature review of reported cases of fungal keratitis or endophthalmitis in KPro patients from January 2001 to June 2015, ii) An in vitro time kill assay characterizing the fungicidal and sporicidal activity of 0.01% hypochlorous acid against a selection of medically relevant fungi.
Results: Fifteen publications were identified, consisting of predominantly retrospective case series. Infection rates following KPro implantation ranged from 0.009-0.02 fungal infections per patient-year of follow-up. The largest single surgeon series reported an incidence of 2.4% for fungal endophthalmitis during a 10-year period. Causative organisms included both yeasts and molds, with Candida species, particularly C. parapsilosis causing the majority of infections in KPro patients in northern North America. Hypochlorous acid, 0.01%, is rapidly fungicidal, reducing the number of viable yeast cells or mold conidia by at least 99.99% within 60 seconds. Its broad-spectrum of activity extended to all molds (Acremonium kiliense, Aspergillus flavus, Aspergillus fumigatus, Fusarium solani, Mucor indicus) and yeast species (Candida albicans, Candida parapsilosis) tested.
Conclusions: Fungal infections remain a lifelong concern in patients following KPro implantation. There is a pressing need for a standardized antifungal prophylaxis regime, particularly in the developing world where fungi are endemic and resources for treatment limited. The rapid broad-spectrum in vitro fungicidal activity of 0.01% hypochlorous acid against all fungi tested makes it a promising candidate as an antifungal prophylaxis agent in KPro patients.
AAO Disclosure Code: E

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