title: Microbial keratitis after intrastromal corneal ring segment implantation.
abstract: OBJECTIVE
  To evaluate the incidence of acute microbial keratitis after intrastromal corneal ring segment implantation and to investigate whether microbial keratitis is related to the intrastromal corneal ring type or surgical technique.
  
  
  METHODS
  Intrastromal corneal ring segments were implanted in 212 eyes of 149 patients. Two different types of intrastromal corneal ring segments were used during the study, Intacs and Ferrara rings, and two surgical techniques were used for intrastromal corneal ring segment implantation, manual and femtosecond laser.
  
  
  RESULTS
  One hundred thirty-four eyes (63.2%) underwent Intacs implantation and 78 (36.8%) eyes received Ferrara rings. Corneal tunnels were created using the manual technique in 119 (56.1%) eyes and by femtosecond laser in 93 (43.9%) eyes. Three cases (1.4%) of acute microbial keratitis were clinically identified. Cultures were positive in 2 eyes and negative in 1 eye, and polymerase chain reaction was positive in all 3 cases. The microorganisms isolated from cultures were Streptococcus mitis and Staphylococcus aureus. In 2 cases, the femtosecond laser technique was used (1 eye Intacs, 1 eye Ferrara), and in 1 case, the manual technique was used (Intacs). No statistically significant difference was noted between techniques (P=.582) or segment type (P=1.000). In all cases, intrastromal corneal ring segments were explanted and intensive topical antibiotics were used with clinical success.
  
  
  CONCLUSIONS
  Acute microbial keratitis incidence after intrastromal corneal ring segment implantation was 1.4%. Gram-positive cocci were the organisms isolated more frequently. Proper management of this condition requires intrastromal corneal ring segment explantation and intensive topical antibiotics.
authors.affiliation: Department of Ophthalmology, Miguel Hernández University, Alicante, Spain. rdioa@vissum.com
authors.forename: M Emilia
authors.initials: ME
authors.lastname: Mulet
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Pérez-Santonja
authors.forename: Consuelo
authors.initials: C
authors.lastname: Ferrer
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Alió
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003319:Corneal Stroma / Q000601:surgery*; D003320:Corneal Ulcer / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D020878:Device Removal; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000009:adverse effects*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013290:Streptococcal Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D034361:Streptococcus mitis / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents