Infectious and noninfectious keratitis after laser in situ keratomileusis Occurrence, management, and visual outcomes.
OBJECTIVE
To retrospectively review the occurrence, treatment, and visual outcomes associated with various etiologies of keratitis as a postoperative complication of laser in situ keratomileusis (LASIK) at an academic surgical center.


METHODS
John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.


METHODS
The charts of 5618 post-LASIK patients (10 477 eyes) were reviewed for the development of keratitis. Occurrence rates, management regimens, and final best spectacle-corrected visual acuity (BSCVA) were reported for infectious and noninfectious keratitis etiologies.


RESULTS
Post-LASIK keratitis was diagnosed in 279 eyes. The keratitis was diagnosed as infectious in 33 eyes (12%) and as noninfectious in 246 eyes (88%). Infectious cases included 5 eyes (15%) with herpes simplex keratitis (HSV), 18 (55%) with adenoviral keratitis, and 10 (30%) with nonviral (including bacterial, fungal, and parasitic) keratitis. Of noninfectious cases, 193 (78%) were classified as diffuse lamellar keratitis (DLK), 36 (15%) as staphylococcal marginal hypersensitivity, and 17 (15%) as localized debris-related keratitis.


CONCLUSIONS
The occurrence of post-LASIK keratitis was 2.66%, with DLK being the most common diagnosis overall. The occurrence of noninfectious keratitis (2.34%) was 7.5 times greater than the occurrence of infectious keratitis (0.31%). Adenoviral keratitis had the best visual outcomes overall, with all 18 patients achieving 20/20 BSCVA. In contrast, all 5 eyes with HSV keratitis lost 1 or 2 lines of BSCVA. Excluding adenoviral keratitis, infectious etiologies had significantly worse visual outcomes than noninfectious etiologies at the 20/40 and 20/20 levels (P = .0013 and P<.001, respectively).
Moshirfar
Majid
M
Department of Ophthalmology, University of Utah, Salt Lake City, Utah, USA. majid.moshirfar@hse.utah.edu
Welling
John D
JD
Feiz
Vahid
V
Holz
Huck
H
Clinch
Thomas E
TE
D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D015817:Eye Infections / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007634:Keratitis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D020731:Keratomileusis, Laser In Situ; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D014792:Visual Acuity / Q000502:physiology*
D000890:Anti-Infective Agents