title: Corneal inlay implantation complicated by infectious keratitis.
abstract: OBJECTIVE
  To report five cases of infectious keratitis following corneal inlay implantation for the surgical correction of presbyopia.
  
  
  METHODS
  This was a retrospective, observational case series. Five eyes of five patients were identified consecutively in two emergency departments during a 1-year period, from November 2013 to November 2014. Patients' demographics, clinical features, treatment and outcomes are described.
  
  
  RESULTS
  There were four female patients and one male, aged 52-64 years. Three patients had the KAMRA inlay (AcuFocus) and two had the Flexivue Microlens inlay (Presbia Coöperatief U.A.) inserted for the treatment of presbyopia and they presented from 6 days to 4 months postoperatively. Presenting uncorrected vision ranged from 6/38 to counting fingers. One patient's corneal scrapings were positive for a putatively causative organism, Corynebacterium pseudodiphtheriticum, and all patients responded to broad-spectrum fortified topical antibiotics. All patients lost vision with final uncorrected visual acuity ranging from 6/12 to 6/60 and best-corrected vision ranging from 6/7.5 to 6/12. Two patients' corneal inlays were explanted and three remained in situ at last follow-up.
  
  
  CONCLUSIONS
  Infectious keratitis can occur at an early or late stage following corneal inlay implantation. Final visual acuity can be limited by stromal scarring; in the cases where the infiltrate was small and off the visual axis at the time of presentation, the final visual acuity was better than those patients who presented with larger lesions affecting the visual axis. Though infection may necessitate removal of the inlay, early positive response to treatment may enable the inlay to be left in situ.
authors.affiliation: Royal Victoria Eye and Ear Hospital, Dublin, Ireland.
authors.forename: Emma S
authors.identifier: http://orcid.org/0000-0002-3968-4855
authors.initials: ES
authors.lastname: Duignan
authors.affiliation: Royal Victoria Eye and Ear Hospital, Dublin, Ireland.
authors.forename: Stephen
authors.initials: S
authors.lastname: Farrell
authors.affiliation: Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: Maxwell P
authors.initials: MP
authors.lastname: Treacy
authors.affiliation: Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: Tim
authors.initials: T
authors.lastname: Fulcher
authors.affiliation: Royal Victoria Eye and Ear Hospital, Dublin, Ireland.
authors.forename: Paul
authors.initials: P
authors.lastname: O'Brien
authors.affiliation: Royal Victoria Eye and Ear Hospital, Dublin, Ireland.
authors.forename: William
authors.initials: W
authors.lastname: Power
authors.affiliation: Royal Victoria Eye and Ear Hospital, Dublin, Ireland Department of Ophthalmology, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Conor C
authors.initials: CC
authors.lastname: Murphy
mesh_terms: D000180:Acrylic Resins; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001672:Biocompatible Materials; D003319:Corneal Stroma / Q000601:surgery*; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D003352:Corynebacterium / Q000302:isolation & purification; D003354:Corynebacterium Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ; D054018:Lasers, Excimer / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011145:Polyvinyls; D011305:Presbyopia / Q000503:physiopathology / Q000601:surgery*; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D012189:Retrospective Studies; D005465:Fluorocarbon Polymers
chemical_list: D000180:Acrylic Resins; D000900:Anti-Bacterial Agents; D001672:Biocompatible Materials; D011145:Polyvinyls; C024865:polyvinylidene fluoride; D005465:Fluorocarbon Polymers; C006903:carbopol 940
keywords: Cornea; Infection