Acinetobacter and Staphylococcus aureus ulcerative keratitis after laser in situ keratomileusis treated with antibiotics and phototherapeutic keratectomy.
OBJECTIVE
To report a method of treatment for through-the-flap multibacterial ulcerative keratitis after laser in situ keratomileusis (LASIK).


METHODS
Bacterial ulcerative keratitis after LASIK was treated with topical and systemic antibiotics followed by flap lifting, cleaning, and phototherapeutic keratectomy (PTK). Follow-up examinations included in vivo confocal microscopy, corneal topography, and wavefront analysis.


RESULTS
Rapid recovery of the ulcerative keratitis was observed after flap lifting and cleaning of the interface and PTK combined with topical and systemic antibiotics. Two years postoperatively, corneal topography showed a slight depression of the ulcer area and decentration of the photoablation. Wavefront analysis revealed an irregular scan with a pronounced coma-like aberration, which with a wavefront-guided custom test lens correction provided 20/16 visual acuity.


CONCLUSIONS
Ulcerative bacterial keratitis is a possible sight-threatening complication of LASIK refractive surgery. Lifting and rinsing the flap combined with cleaning of the flap interface with PTK may be helpful in these conditions when regression of the ulcer does not occur with topical and oral antibiotic treatment.
Lindbohm
Nina
N
Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland.
Moilanen
Jukka A O
JA
Vesaluoma
Minna H
MH
Tervo
Timo M T
TM
D000150:Acinetobacter / Q000302:isolation & purification; D000151:Acinetobacter Infections / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D000328:Adult; D000900:Anti-Bacterial Agents; D003131:Combined Modality Therapy; D019781:Corneal Topography; D003320:Corneal Ulcer / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D054018:Lasers, Excimer; D008297:Male; D018613:Microscopy, Confocal; D018903:Photorefractive Keratectomy / Q000379:methods*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013524:Surgical Flaps / Q000382:microbiology
D000900:Anti-Bacterial Agents