Infectious Keratitis after Photorefractive Keratectomy in the United States Army and Navy
Received 27 December 2004; accepted 6 September 2005. published online 16 February 2006.
Purpose
To review the incidence, culture results, clinical course, management, and visual outcomes of infectious keratitis after photorefractive keratectomy (PRK) at 6 Army and Navy refractive surgery centers.
Design
Retrospective study.
Participants
Twelve thousand six hundred sixty-eight Navy and Army sailors and service members.
Methods
Army and Navy refractive surgery data banks were searched for cases of infectious keratitis. A retrospective chart review and query of the surgeons involved in the care of those patients thus identified provided data regarding preoperative preparation, perioperative medications, treatment, culture results, clinical course, and final visual acuity.
Results
Between January 1995 and May 2004, we performed a total of 25337 PRK procedures at the 6 institutions. Culture proven or clinically suspected infectious keratitis developed in 5 eyes of 5 patients. All patients received topical antibiotics perioperatively. All cases presented 2 to 7 days postoperatively. Cultures from 4 cases grew Staphylococcus, including 2 methicillin-resistant S. aureus (MRSA). One case of presumed infectious keratitis was culture negative. There were no reported cases of mycobacterial or fungal keratitis. In addition, we identified 26 eyes with corneal infiltrates in the first postoperative week that were felt to be sterile, and which resolved upon removal of the bandage contact lens and increasing antibiotic coverage.
Conclusions
Infectious keratitis is a rare but potentially vision-threatening complication after PRK. It is often caused by gram-positive organisms, including MRSA. Early diagnosis, appropriate laboratory testing, and aggressive antimicrobial therapy can result in good outcomes.
1Kimbrough Army Health Clinic, Fort Meade, Maryland.
2National Naval Medical Center, Bethesda, Maryland.
3Center for Refractive Surgery, Walter Reed Army Medical Center, Washington, DC.
4Department of Ophthalmology, Naval Medical Center, San Diego, California.
5Womack Army Medical Center, Fort Bragg, North Carolina.
7Ophthalmology Service, Madigan Army Medical Center, Fort Lewis, Washington.
Correspondence to Keith J. Wroblewski, MD, Deputy Commander for Clinical Services and Ophthalmology, Kimbrough Ambulatory Care Center, Fort Meade, MD 20755-5800.
Manuscript no. 2004-448
There was no financial support, public or private, used to fund the study. The authors have no financial interest in any product, drug, instrument, or equipment discussed in the article
The opinions expressed in the article are those solely of the authors and do not represent the views or official policies of the United States Army or Department of Defense
ABSTRACT