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

Publication date: Sep 23, 2025

To evaluate the risk factors and outcomes of developing endophthalmitis in patients with Boston Type 1 keratoprosthesis (KPro) during the COVID-19 pandemic. Retrospective single-center cohort study. 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. 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. 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. 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.

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