%0 Journal Article %J Acta Ophthalmol %D 2014 %T Infectious endophthalmitis in Boston keratoprosthesis: incidence and prevention %A Behlau, Irmgard %A Martin, Kathryn V %A Martin, Jacqueline N %A Naumova, Elena N %A Cadorette, James J %A Sforza, J Tammy %A Pineda, Roberto %A Dohlman, Claes H %K Antibiotic Prophylaxis %K Bioartificial Organs %K Cornea %K Endophthalmitis %K Eye Infections, Bacterial %K Eye Infections, Fungal %K Global Health %K Humans %K Incidence %K Prosthesis Implantation %K Retrospective Studies %K Risk Factors %K United States %K Visual Acuity %X PURPOSE: To determine the cumulative worldwide incidence of infectious endophthalmitis and associated vision loss after Boston keratoprosthesis (B-KPro) Type I/II implantation and to propose both safe and inexpensive prophylactic antibiotic regimens. METHODS: Two retrospective methods were used to determine the incidence, visual outcomes and aetiologies of infectious endophthalmitis associated with the B-KPro divided per decade: (i) systematic review of the literature from 1990 through January 2013 and (ii) a surveillance survey sent to all surgeons who implanted B-KPros through 2010 with 1-year minimum follow-up. In addition, a single-Boston surgeon 20-year experience was examined. RESULTS: From 1990 through 2010, there were 4729 B-KPros implanted worldwide by 209 U.S. surgeons and 159 international surgeons. The endophthalmitis cumulative mean incidence declined from 12% during its first decade of use to about 3% during its second decade in the Unites States and about 5% internationally during the second decade. There remains a large incidence range both in the United States (1-12.5%) and internationally (up to 17%). Poor compliance with daily topical antibiotics is an important risk factor. While Gram-positive organisms remained dominant, fungal infections emerged during the second decade. CONCLUSIONS: Daily prophylactic topical antibiotics have dramatically reduced the endophthalmitis incidence. Although Gram-positive organisms are the most common aetiology, antimicrobials must be inclusive of Gram-negative organisms. Selection of prophylactic regimens should be tailored to local antibiotic susceptibility patterns, be cost-effective, and should not promote the emergence of antimicrobial resistance. An example of a broad-spectrum, low-cost prophylactic option for non-autoimmune patients includes trimethoprim/polymyxinB once daily. %B Acta Ophthalmol %V 92 %P e546-55 %8 2014 Nov %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/24460594?dopt=Abstract %R 10.1111/aos.12309