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Evaluation of Microbial Flora in Eyes With a Boston Type 1 Keratoprosthesis

Lee, Samuel H. MD; Mannis, Mark J. MD; Shapiro, Brett MD; Li, Jennifer Y. MD; Polage, Christopher MD; Smith, Wayne PhD

doi: 10.1097/ICO.0b013e3182a81992
Clinical Science

Purpose: To evaluate the microbial flora of eyes with a Boston Keratoprosthesis (K-Pro).

Methods: A prospective study was performed for 17 eyes of 15 patients who underwent a K-Pro implantation between September 2005 and June 2011. Preoperative diagnoses included failed corneal grafts, limbal stem cell deficiency, chemical burns, and Stevens–Johnson Syndrome. The patients used topical antibiotics after their surgery including a fluoroquinolone, polymyxin–trimethoprim, vancomycin, or a combination of the 3. The conjunctiva in the study eye was swabbed and cultured. A separate culture was taken of the contralateral eye as well. If available, the bandage contact lens was removed, and half of it was placed in thioglycolate broth, and half in 5 mL of a sterile balanced salt solution. The contact lens in the balanced salt solution was sonicated using a QSonica Q125 sonicator (Newtown, CT) for 1 minute, at an amplitude of 20%. Ten microliters of fluid was subsequently cultured.

Results: Of the patients who underwent the K-Pro surgery during that time period, 15 patients with 17 eyes were able to participate in the data collection. Nine of the 17 eyes implanted with the K-Pro (53%) had positive cultures. Two of the 13 (15%) of the control swabs exhibited bacterial growth. Eight percent (1/12) of the sonicated lenses were positive on culture, whereas 4/12 (33%) of the lenses placed in thioglycolate broth were positive for organisms.

Conclusions: Despite being on antibiotics, eyes implanted with the K-Pro were more likely to have a positive conjunctival culture in our cohort as compared with that of fellow eyes.

*UC Davis Health System Eye Center, Sacramento, CA; and

Department of Pathology and Laboratory Medicine, UC Davis Medical Center, Sacramento, CA.

Reprints: Mark J. Mannis, UC Davis Eye Center, 4860 Y St, Suite 2400, Sacramento, CA 95817 (e-mail:

Supported by Research to Prevent Blindness.

Received June 12, 2013

Accepted August 03, 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.