Late bacterial keratitis after intracorneal ring segments (Ferrara ring) insertion for keratoconus.
OBJECTIVE
To report a case of late bacterial keratitis after intrastromal corneal ring segments (ICRSs; Ferrara ring; Ferrara Ophthalmics, Belo Horizonte, Brazil).


METHODS
Review the clinical findings in a 42-year-old woman with bilateral keratoconus who underwent implantation of Ferrara ring segments in her left eye and 4 months later presented with corneal infiltrates and hypopyon. Bacterial staining, culture, and antibiotic sensitivities were done. Medical treatment and rings explantation were performed.


RESULTS
The cultures revealed growth of vancomycin-oxacillin sensible coagulase-positive Staphylococcus aureus. Treatment with topical moxifloxacin, topical imipenem, and systemic intravenous and topical vancomycin was kept for two weeks. Corneal inflammation and hypopyon resolved, leaving a minimal residual leucoma.


CONCLUSIONS
Infectious keratitis is an uncommon complication of ICRS and it may be late in presentation, even months after implantation. Importance of patient education about alarm symptoms and the need for long-term close postoperative follow-up cannot be underestimated. If a change in surgical technique, i.e., suturing the incision, has an influence in this complication's incidence, it will require further studies.
Galvis
Virgilio
V
Centro Oftalmológico Virgilio Galvis Bucaramanga, Santander, Colombia. virgiliogalvis@gmail.com
Tello
Alejandro
A
Delgado
Julián
J
Valencia
Fabián
F
Gómez
Augusto J
AJ
Diaz
Luis A
LA
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001372:Aza Compounds / Q000627:therapeutic use; D003319:Corneal Stroma / Q000601:surgery*; 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*; D005260:Female; D024841:Fluoroquinolones; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D007640:Keratoconus / Q000601:surgery*; D008826:Microbial Sensitivity Tests; D000077266:Moxifloxacin; D011183:Postoperative Complications; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D011804:Quinolines / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D014640:Vancomycin; D015378:Imipenem; D000077266:Moxifloxacin