Infectious keratitis after photorefractive keratectomy.
OBJECTIVE
To elucidate risk factors, microbial culture results, and visual outcomes for infectious keratitis after photorefractive keratectomy (PRK).


METHODS
Multicenter, retrospective chart review, case report, and literature review.


METHODS
The records of 12 patients with infectious keratitis after PRK were reviewed.


METHODS
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.
Donnenfeld
Eric D
ED
Department of Ophthalmology, Nassau University Medical Center, East Meadow, New York, USA.
O'Brien
Terrence P
TP
Solomon
Renée
R
Perry
Henry D
HD
Speaker
Mark G
MG
Wittpenn
John
J
D000328:Adult; D002939:Ciprofloxacin / Q000627:therapeutic use; D003320:Corneal Ulcer / Q000188:drug therapy / Q000382:microbiology*; D003428:Cross Infection / Q000382:microbiology; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D054018:Lasers, Excimer; D016106:Methicillin Resistance; D018903:Photorefractive Keratectomy / Q000009:adverse effects*; D011113:Polymyxins / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology; D013290:Streptococcal Infections / Q000188:drug therapy / Q000209:etiology; D014031:Tobramycin / Q000627:therapeutic use; D014295:Trimethoprim / Q000627:therapeutic use; D014792:Visual Acuity
D011113:Polymyxins; D002939:Ciprofloxacin; D014295:Trimethoprim; D014031:Tobramycin