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Recurrent idiopathic vitreous inflammation after Boston keratoprosthesis

Session Details

Session Title: Cornea

Session Date/Time: Sunday 16/02/2014 | 08:30-11:00

Paper Time: 10:27

Venue: Linhart Hall (Level -2)

First Author: : ChristinaGrassi USA

Co Author(s): :    Alja Crnej   Kathryn Colby   Claes Dohlman   James Chodosh     

Abstract Details

Purpose:

To report outcomes of cases with repeat idiopathic culture-negative vitreous inflammation after Boston keratoprosthesis (KPro).

Setting:

Massachusetts Eye and Ear Infirmary, Boston, MA

Methods:

A retrospective chart review of 353 adult patients with a keratoprosthesis, performed by three surgeons (JC, KC, CHD) at Massachusetts Eye and Ear Infirmary between January 2000 and August 2013.

Results:

23/353 KPro recipients developed idiopathic, culture negative vitreous inflammation. 10/23 had repeat episodes (32 total events, median 3, range 2-7, mode 3). Of these 10, 3 were aphakic, and 7 were pseudophakic. 3 had an underlying auto-immune disease. 3 patients had a glaucoma shunt in place at time of first episode of vitritis. 9 were type I KPros. Prior to the episode, all patients were on a fluoroquinolone, 7 on prednisolone acetate, and 2 on Vancomycin. 1 patient reported noncompliance. Median time from KPro implantation to first episode was 6.7 months (range 2.5 months to 8.5 years). Mean time between episodes was 8.66 months (range 2 wks to 7.2 yrs). On presentation, 23 episodes received retrotenons triamcinolone acetate and 4 episodes received a vitreous tap and injection of vancomycin and ceftazamine. All patients presented with visual acuity (VA) loss and 2 patients had symptoms mimicking infectious endophthalmitis. 23 episodes resolved on triamcinolone acetate plus topical medications. 9 episodes resolved with an aggressive increase in topical steroids and vancomycin only. 3 patients were initially non-responsive to topical steroids but responded to retrotenons triamcinolone acetate injection. In 2, a pars plana vitrectomy was performed. 27/32 episodes recovered to baseline VA.

Conclusions:

Many cases of sterile vitreous inflammation after KPro have no identifiable trigger, and roughly 45% of cases recurred in our population. These cases recurred despite being on a topical steroid regimen. Clinicians should be aware that repeat idiopathic vitreous inflammation may be difficult to treat and in many cases, require an aggressive increase in topical steroids coupled with one or more triamcinolone acetate injections to resolve. FINANCIAL INTEREST: NONE