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Review
. 2015 Dec;34(12):1599-605.
doi: 10.1097/ICO.0000000000000639.

Fungal Infections After Boston Type 1 Keratoprosthesis Implantation: Literature Review and In Vitro Antifungal Activity of Hypochlorous Acid

Silvia Odorcic  1 , Wolfgang Haas, Michael S Gilmore, Claes H Dohlman
Affiliations
Review

Fungal Infections After Boston Type 1 Keratoprosthesis Implantation: Literature Review and In Vitro Antifungal Activity of Hypochlorous Acid

Silvia Odorcic et al. Cornea. 2015 Dec.

Abstract

Purpose: To review the current literature describing cases of fungal keratitis and endophthalmitis after Boston keratoprosthesis (KPro) implantation and to characterize the antifungal activity of 0.01% hypochlorous acid against medically relevant fungi.

Methods: A literature review of fungal keratitis or endophthalmitis in KPro patients from January 2001 to April 2015, and an in vitro time kill assay characterizing the fungicidal activity of 0.01% hypochlorous acid against fungi causing ocular infections.

Results: Fifteen publications, predominantly retrospective case series, were identified. Infection rates after KPro implantation ranged from 0.009 to 0.02 fungal infections per patient-year of follow-up. The largest single-surgeon series reported an incidence of 2.4% for fungal endophthalmitis during a 10-year period. Causative organisms included both yeasts and molds. Outcomes were favorable if infections were caught early and treated appropriately; less favorable outcomes were reported in developing countries where fungal species are endemic and resources are limited. 0.01% hypochlorous acid is rapidly fungicidal, reducing the number of viable yeast cells or mold conidia by at least 99.99% within 60 seconds. The antifungal activity extended to all molds (Acremonium kiliense, Aspergillus flavus, Aspergillus fumigatus, Fusarium solani, and Mucor indicus) and yeast species (Candida albicans and Candida parapsilosis) tested.

Conclusions: Fungal infections remain a lifelong concern in patients after KPro implantation. There is a growing need for a standard antifungal prophylaxis regimen, especially in the developing world. The rapid broad-spectrum in vitro fungicidal activity of 0.01% hypochlorous acid against all fungi tested makes it an attractive candidate as an antifungal prophylaxis in KPro patients.

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Conflict of interest statement

Conflict of Interest: All authors are full time employees of Massachusetts Eye and Ear Infirmary (a not-for-profit organization) which is the manufacturer of the Boston Keratoprosthesis.

Figures

Figure 1
Figure 1
Figure 1A. Fungal colonization: white, mulberry shaped deposits on the soft contact lens. Figure 1B. Active fungal keratitis: white sheen around the optic stem.
Figure 1
Figure 1
Figure 1A. Fungal colonization: white, mulberry shaped deposits on the soft contact lens. Figure 1B. Active fungal keratitis: white sheen around the optic stem.
See this image and copyright information in PMC

References

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