Bilateral bacterial keratitis in three patients following photorefractive keratectomy.
OBJECTIVE
To report clinical manifestations and the bacteriologic profiles of three patients with bilateral bacterial keratitis following photorefractive keratectomy (PRK).


METHODS
Photorefractive keratectomy was performed for mild to moderate myopia or compound myopic astigmatism. Bandage contact lenses were fitted at the conclusion of each surgery. Bilateral infectious keratitis was diagnosed within 3 days after surgery. Smear and culture were obtained in all three cases. Patients were treated with topical fortified antibiotics (cefazolin and gentamicin).


RESULTS
All patients presented with severe bilateral ocular pain, photophobia, purulent discharge, and dense corneal infiltration. Causative organisms were Staphylococcus aureus (n = 2) and Streptococcus pneumoniae (n = 1). Ulcers were controlled with aggressive medical therapy in five eyes; however, tectonic penetrating keratoplasty was required in one eye.


CONCLUSIONS
Uncontrolled blepharitis and bandage contact lens use appears to play a role in the development of bacterial keratitis after PRK. Avoidance of simultaneous bilateral surgery in patients with risk factors for bacterial keratitis, preoperative control of blepharitis, and good contact lens hygiene is suggested.
Karimian
Farid
F
Cornea and Anterior Segment Service, Department of Ophthalmology, Labbafinejad Medical Center, Shaheed Beheshti Medical University, Tehran, Iran. karimianf@yahoo.com
Baradaran-Rafii
Alireza
A
Javadi
Mohammad-Ali
MA
Nazari
Roshanak
R
Rabei
Hossein Mohammad
HM
Jafarinasab
Mohammad-Reza
MR
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002437:Cefazolin / Q000627:therapeutic use; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D054018:Lasers, Excimer; D008297:Male; D008875:Middle Aged; D018903:Photorefractive Keratectomy; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D011183:Postoperative Complications; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D013296:Streptococcus pneumoniae / Q000302:isolation & purification
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D002437:Cefazolin