Infectious keratitis after photorefractive keratectomy in the United States army and navy.
OBJECTIVE
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.


METHODS
Retrospective study.


METHODS
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.
Kimbrough Army Health Clinic, Fort Meade, Maryland, USA.
Keith J
KJ
Wroblewski
Joseph F
JF
Pasternak
Kraig S
KS
Bower
Steven C
SC
Schallhorn
Walter J
WJ
Hubickey
Cary E
CE
Harrison
Mark F
MF
Torres
Scott D
SD
Barnes
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001251:Astigmatism / Q000601:surgery; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000601:surgery; D015994:Incidence; D054018:Lasers, Excimer; D008297:Male; D016106:Methicillin Resistance; D008887:Military Medicine; D008889:Military Personnel; D009216:Myopia / Q000601:surgery; D018903:Photorefractive Keratectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D013210:Staphylococcus / Q000302:isolation & purification; D014481:United States; D014792:Visual Acuity
D000900:Anti-Bacterial Agents