Intrastromal Corneal Ring Implants Associated Bacterial Infections

Figures & data

Table 1. Characteristics of the studies included placement of ICRS.

Reference; country	Male: female ratio, mean age of patients (years)	Incision depth (% of corneal depth)	Study duration month (years)	Type of study	Implant numbers	Presurgery antibiotic/analgesia	Follow up period (months)	Number of infections (%)	Micro-organism	Complication rate (%)	Post-infection therapy	Vision status of keratitis patients	Risk factor
Oria et al. (2020), Spain	66:53, 34 ± 11	70	61	RMCOCS	1,644	Ceft, Antb	3	7 (5.8)	NA	6	Fortified Antb	NA	Extrusion
Tabatabaei et al. (2019), Iran	8:3, 29 ± 7.31	NA	14	RCS	82	Chlo, Bm	6	11 (13.4)	Sa 4, Se 5, Sv 1, NG 1	NI	Van, Cef, Ami	9 RG	Gap
Steinberg et al. (2019) Germany	NA	NA	04	RC (8centers)	1517	NA	4	1 (0.07)	NA	NA	Antb	RG/RI	NA
Nguyen et al. (2018) USA	423:149, 35 ± 11	75	156	RCS	572	Antb, Cs	3	1 (3)	NG	6	Gat, Van	RG(20/25)	Extrusion
Mounir et al. (2018) Egypt	−22:27 ± 4.54	80	48	RS	623	Mox, Pred	12	4 (0.64)	Sa 2, P. Spp 2	13	Antb	Opacification	Trauma-2 Unidentifie-2,
Coskunseven at al (2011) Turkey	−28.32 ± 7.28	80	NA	RCR	850	Anaesthetic drops	7	1 (0.1)	NA	6	Antb	NA	Superficial placement
Kugler et al. (2011) USA	3 + 1:0, 51.3 ± 9.85	NA	3	ROCS	279	NA	3	4 (1.4)	S spp 1	NA	NA	NA	Gap, melting
Ferrer et al. (2010) Spain	24:23,-36.7 ± 9.75	70	>6	MNRCCS	250	NA	6	4 (6.9)	Sa 1, Sm 1, NG 2	48	NA	–	Extrusion
Mulet et al. (2009) Spain	125:87, 34.78 ± 10.71	80	84	RCS	212	Cefu, Tob, Dex	6	3 (1.4)	Sa 1, Sm 1, NG 1,	NA	Ceft, Ami, Of; Cefa, Cip	RG	NA
Zare et al. (2007) Iran	17:5, 25.93 ± 5.29	70	6	PCS	30	Cip, Dex	6	1 (3.3)	NA	10	Fortified Antibiotics	RG	Melting
Shabeyek et al. (2007) Spain	12:4, 32 ± 10.16	80	6	PCIS	21	Cip, oxyb	6	1 (4.8)	NA	38	Van, Ofl, Dex; Tob, Dex	RG	Gap
Kanellopulos et al. (2006) USA	6:9, 30.2 ± 5.44	70	12	PNRCS	20	Ofl, Pred	6	1 (5)	No 1	35	Ofl, Pred	Scar	Melting
Lima et al. (2004) Brazil	3:5, 34 ± 6.5	NA	26	RR	499	Tob	26	8 (1.6)	Sa 2, Sv 1, Sp 1 Ps 1, Kspp 1, Fun 1	NA	NA	2 PK	Diabetes, trauma, contact lens use
Kwitco et al. (2004) Brazil-Ferrer (Acrylic)	NA	70	39	RNCICS	51	Kek, Tob, methylcellulose	6	1 (1.9)	Se 1	27	Of, ceph	RG	Trauma, Extrusion
Marinda et al. (2003) Brazil-Ferrer	18:17, 25.72 ± 7.78	80	12	PCS	36	Antb, Cs	12	1 (2.7)	Noc spp	42	Antb	RG	Extrusion
Ruchofer et al. (2001) Europe	47:60,32.5 ± 7	NA	12	12 EIS	163	Tob, Dex	12	1 (0.6)	NG	8(2% intra-operative complications removed from study)	Antb	RG(20/32)	Gap
Shanzlin at al 2001&1997) USA	>21	68	24	US II-91, III 361pat	447	Tob	24	1 (0.2)	NA	2%	NA	RG	Shallow placement

Abbreviations: Ami-amikacin, Antb-antibiotics, AF-anatomic failure, AM-amniotic membrane, Bm-betamethasone, CT/R-Retrospective cohort/chart study/Review, Cefu-cefuroxime, Ceft-ceftazidime, Ceph- cephalothin, Chlo-chloramphenicol, Cip-ciprofloxacin, CL- contact lens, Cs-corticosteroids, Cy-cyclopentolate, Cz-cefazoline, Dex-dexamethasone, DM-diabetes mellites, mEIS-European investigational site, FF-functional failure, Er-extrusion rate, Exr-explantation rate, Ext-extrusion, EM-electron microscope, Fun-fungus, Gat-gatifloxacin, Gen-gentamicin, Kek-ketorolac, K spp-Klebsiella spp, MNRCCS-Multicentre nonrandomized consecutive case series, Mox-moxifloxacin, NA-not available, NG-no growth, NC-not confirmed, Oxy-oxybuprocaine, Of-ofloxacin, Opac-opacification, PCS-Prospective case series study, PCIS-Prospective consecutive interventional study, PNRCS-Prospective non-randomized/comparative case series, P spp- Pseudomonas species, Pred-prednisolone, PVPI-povidone iodine, PK-penetration keratoplasty, ROCS-Retrospective observational case series, RF-refractive failure, RG-regained, RI-reimplanted, S-steroids, Se-Staphylococcus epidermidis, Sa-S aureus, SE-spontaneous extrusion, Sm-S. mitis, Sp-Streptococcus pneumoniae, Sv-S. viridans, Tob-tobramycin, T-trauma, Van-vancomycin, VA- visual acuity, W-wound.

Figure 1. Preferred Reporting Items for Systematic Reviews (PRISMA) flow diagram for selection of articles in this study.

Figure 2. Breakdown between Gram-positive cocci (GPC) and Gram-negative bacilli (GNB) pathogens identified in ICRS infections across the various countries.

Table 2. Newcastle-Ottawa Scale for quality assessment of included observational studies.

Study Country, [reference]	Methodological quality (max 5 stars)	Comparability (max 2 stars)	Outcome measures and analysis (max 3 stars)	Total score – out of possible 10
Spain^1	3	2	1	6
Spain^2	2	2	1	5
Spain^3	4	2	2	8
Spain^4	3	2	1	6
USA^5	4	1	2	7
USA^6	3	1	1	5
USA^7	3	2	1	6
USA^8	3	2	1	6
USA^9	3	1	2	6
Brazil^10	2	1	2	5
Brazil^11	3	1	1	5
Brazil^12	2	2	2	6
Iran^13	4	2	2	8
Iran^14	3	2	0	5
Germany^15	0	0	1	1
Europe^16	4	2	2	8
Egypt^17	3	2	2	7

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Data availability statement

The datasets analysed using core scientific databases. Derived data supporting the findings of this study are available from the corresponding author, Sara M., upon request.