Purpose: To investigate characteristics and prognosis of fungal keratitis following Boston keratoprosthesis (Boston KPro) implantation.
Patients and methods: Patients who had undergone Boston KPro implantation from January 2008 to March 2015 at Miyata Eye Hospital were included in this study. We used medical records to retrospectively investigate the incidence of fungal keratitis, time from Boston KPro implantation to onset of fungal keratitis, patient age, corrected visual acuity (logMAR), causative fungus, and course of treatment.
Results: Eleven eyes of nine patients were subject to analysis. The postoperative follow-up was for 59.8±15.8 months; four eyes (36.4%) in four patients exhibited fungal keratitis and its incidence was 0.090 patients per year. The time from Boston KPro implantation to onset of fungal keratitis was 33.3±26.3 months, and the mean age of patients at the time of onset was 60.0±20.6 years. Corrected visual acuity was 0.29±0.38 before onset and 1.29±1.28 after treatment. No fungi were detected by smear microscopy or culture tests in any of the patients. However, polymerase chain reaction revealed a nucleotide sequence encoding fungal 28S ribosomal RNA in one eye and a nucleotide sequence for the Aspergillus genome in two eyes.
Conclusions: Fungal keratitis following Boston KPro implantation is a serious complication that reduces visual acuity. If signs of infection are noted in the area surrounding Boston KPro, it is important to take into account potential fungal keratitis and consider administering an antifungal agent.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 122: 509-516, 2018.