title: Ulcerative keratitis caused by Serratia marcescens after laser in situ keratomileusis.
abstract: We report 2 cases of severe corneal infections caused by Serratia marcescens after laser in situ keratomileusis (LASIK). Twenty-four hours after LASIK, 2 patients developed infectious keratitis, 1 bilaterally. In each eye, the corneal flap was edematous, ulcerated, and detached from the stromal bed. Treatment included removal of the necrotic flap and aggressive antibiotic therapy. Cultures from corneal exudates were positive for S marcescens. After 1 year, both patients had a loss of best corrected visual acuity (BCVA) ranging from 20/40 to 20/22 because of irregular astigmatism. Overrefraction with a hard contact lens resulted in a BCVA of 20/20 in the 3 affected eyes. Slitlamp examination showed trace subepithelial haze without severe corneal scarring. Videokeratography disclosed areas of paracentral inferior steepening resembling keratoconus. Refraction and videokeratography remained stable after 6 months of follow-up. Ulcerative keratitis caused by S marcescens is a potential complication of LASIK. Bilateral involvement may occur if bilateral simultaneous surgery is performed.
authors.affiliation: Refractive Surgery Department, Instituto Oftalmológico de Alicante, and Division of Ophthalmology, Miguel Hernández University, Alicante, Spain. gon.munoz@terra.es
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Muñoz
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Alió
authors.forename: Juan-José
authors.initials: JJ
authors.lastname: Pérez-Santonja
authors.forename: Alberto
authors.initials: A
authors.lastname: Artola
authors.forename: José Luis
authors.initials: JL
authors.lastname: Abad
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents; D003261:Contact Lenses; D003319:Corneal Stroma / Q000382:microbiology / Q000601:surgery; D019781:Corneal Topography; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008875:Middle Aged; D012029:Refraction, Ocular; D016868:Serratia Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D012706:Serratia marcescens / Q000302:isolation & purification*; D013524:Surgical Flaps / Q000382:microbiology; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D014792:Visual Acuity
chemical_list: D000900:Anti-Bacterial Agents