Infectious keratitis after photorefractive keratectomy☆
Received 15 February 2002; accepted 7 December 2002.
Abstract
Purpose
To elucidate risk factors, microbial culture results, and visual outcomes for infectious keratitis after photorefractive keratectomy (PRK).
Design
Multicenter, retrospective chart review, case report, and literature review.
Methods
The records of 12 patients with infectious keratitis after PRK were reviewed.
Main outcome measures
Causative organism, response to medical treatment, and visual outcome.
Results
Infectious keratitis developed in 13 eyes of 12 patients after PRK. Organisms cultured were Staphylococcus aureus (n = 5), including a bilateral case of methicillin-resistant Staphylococcus aureus; Staphylococcus epidermidis (n = 4); Streptococcus pneumoniae (n = 3); and Streptococcus viridans (n = 1). Four patients manipulated their contact lenses, and 2 patients were exposed to nosocomial organisms while working in a hospital environment. Prophylactic antibiotics used were tobramycin (nine cases), polymyxin B-trimethoprim (three cases), and ciprofloxacin (one case). Final best spectacle-corrected visual acuity ranged from 20/20 to 20/100.
Conclusions
Infectious corneal ulceration is a serious potential complication of PRK. Gram-positive organisms are the most common pathogens. Antibiotic prophylaxis should be broad spectrum and should include gram-positive coverage.
1Department of Ophthalmology, Nassau University Medical Center, East Meadow, New York, USA
2Ophthalmic Consultants of Long Island, Rockville Centre, New York, USA
3Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, Maryland, USA
4Department of Ophthalmology, New York Eye and Ear Infirmary, New York, New York, USA
Correspondence and reprint requests to Eric D. Donnenfeld, MD, Ophthalmic Consultants of Long Island, Ryan Medical Arts Building, Suite 402, 2000 North Village Avenue, Rockville Centre, NY 11570, USA.
ABSTRACT