Clinical Outcomes of Boston Type 1 Keratoprosthesis with and without Endophthalmitis During the Covid-19 Pandemic

Purpose: To evaluate the risk factors and outcomes of developing endophthalmitis in patients with Boston Type 1 keratoprosthesis (KPro) during the COVID-19 pandemic. Design: Retrospective single-center cohort study Methods: Retrospective chart review of all patients with KPro-1 who presented for follow-up at a tertiary eyecare center between January 2003 and May 2023 was performed. Main Outcome Measures: The incidence and risk factors of endophthalmitis in eyes with KPro-1 implantation. Visual outcome at the last follow-up prior to study conclusion after keratoprosthesis implantation. Results: Of 79 Kpro-1 implanted eyes in 67 patients, with median 29 months follow-up, 15 eyes (18%) developed endophthalmitis. Ten of these cases (67%) presented to clinic during the COVID-19 pandemic between March 2020 and May 2023. Black patients had a significantly higher risk of developing endophthalmitis as compared to White patients (p = 0.024). Eyes with bandage contact lens (BCL) usage had a significantly lower risk of developing endophthalmitis (p = 0.032), yet having a prior PPV or consistent use of postoperative antibiotics did not significantly affect endophthalmitis rates (p > 0.1). At the last follow-up, visual outcomes were similar in both endophthalmitis and non-endophthalmitis groups. Conclusions: This KPro cohort, with 67% of patients presenting during the COVID-19 pandemic, had a higher rate of endophthalmitis than previously reported in the literature. Black patients had a higher risk of getting endophthalmitis than White patients. BCL usage appeared to have a protective effect against endophthalmitis, while neither post-operative antibiotic use nor vitrectomy had a significant effect on rates of endophthalmitis.