Fungal Infections in Boston Keratoprosthesis Patients: Lessons Learned and Novel Developments on the Horizon

ABSTRACT

The Boston Keratoprosthesis (B-KPro) is a widely accepted modality of corneal restoration in eyes where traditional penetrating keratoplasty has little chance of success. It is the most commonly used keratoprosthesis worldwide. While the introduction of broad-spectrum antibiotic prophylaxis has virtually eliminated cases of bacterial endophthalmitis, fungal colonization and infections are a growing concern. This review of the literature summarizes risk factors for fungal infections in KPro eyes, rates of fungal infection and colonization, clinical presentation, causative organisms, management, and outcomes. We also focus on current recommendations for antifungal prophylaxis, and highlight the role of translational research at the Massachusetts Eye and Ear Infirmary (MEEI, Boston, USA) with its aim of developing novel strategies for reducing rates of fungal infections in KPro patients.

• Endophthalmitis
• keratitis
• mold
• prophylaxis
• translational research
• yeast

ACKNOWLEDGEMENTS

The authors would like to thank Christine A. Finn, PharmD, RPh, BCPS, Clinical Pharmacy Specialist at the Massachusetts Eye and Ear Infirmary, for her assistance in providing information on antifungal treatments.

DECLARATION OF INTEREST

Authors Claes H. Dohlman, Silvia Odorcic, and Wolfgang Haas are full-time employees of Massachusetts Eye and Ear Infirmary (a not-for-profit organization), which is the manufacturer of the Boston Keratoprosthesis. Author Marlene L. Durand is an employee of Massachusetts General Hospital and also has an appointment at Massachusetts Eye and Ear Infirmary. The authors alone are responsible for the content and writing of this article.