title: Early-onset methicillin-resistant Staphylococcus aureus keratitis and late-onset infectious keratitis in astigmatic keratotomy incision following femtosecond laser-assisted cataract surgery.
abstract: A 79-year-old woman had uneventful femtosecond laser-assisted cataract surgery including paired laser astigmatic keratotomies (AKs) in the right eye. Three weeks postoperatively, a corneal infiltrate developed in the superotemporal AK incision. Cultures grew methicillin-resistant Staphylococcus aureus. The infection was treated with topical fortified vancomycin and tobramycin; full resolution required several months of therapy. Five months after cataract surgery, the patient presented with a second stromal infiltrate, also in the superotemporal AK incision. Despite negative cultures, the infiltrate resolved quickly on a short course of broad-spectrum fortified antibiotics. At 6 months, the corrected distance visual acuity was 20/30. This case demonstrates that infectious keratitis can occur following uneventful femtosecond laser-assisted AK performed concurrently with cataract surgery. We reviewed the literature on infectious keratitis following refractive keratotomy and femtosecond laser-assisted procedures. Several recommendations to prevent these infections are proposed.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From the Department of Ophthalmology (Chou, Abazari, Barash, Kaplowitz), Stony Brook University, Stony Brook, and the Long Island Eye Surgical Care PC (Shah), Brentwood, New York, USA. Electronic address: timothy.chou@stonybrookmedicine.edu.
authors.forename: Timothy Y
authors.initials: TY
authors.lastname: Chou
authors.affiliation: From the Department of Ophthalmology (Chou, Abazari, Barash, Kaplowitz), Stony Brook University, Stony Brook, and the Long Island Eye Surgical Care PC (Shah), Brentwood, New York, USA.
authors.forename: Azin
authors.initials: A
authors.lastname: Abazari
authors.affiliation: From the Department of Ophthalmology (Chou, Abazari, Barash, Kaplowitz), Stony Brook University, Stony Brook, and the Long Island Eye Surgical Care PC (Shah), Brentwood, New York, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Barash
authors.affiliation: From the Department of Ophthalmology (Chou, Abazari, Barash, Kaplowitz), Stony Brook University, Stony Brook, and the Long Island Eye Surgical Care PC (Shah), Brentwood, New York, USA.
authors.forename: Shetal
authors.initials: S
authors.lastname: Shah
authors.affiliation: From the Department of Ophthalmology (Chou, Abazari, Barash, Kaplowitz), Stony Brook University, Stony Brook, and the Long Island Eye Surgical Care PC (Shah), Brentwood, New York, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Kaplowitz
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001251:Astigmatism / 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; D006801:Humans; D007646:Keratotomy, Radial; D053685:Laser Therapy; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D018918:Phacoemulsification; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D014031:Tobramycin / Q000627:therapeutic use; D041623:Tomography, Optical Coherence; D014640:Vancomycin / Q000627:therapeutic use; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D014031:Tobramycin