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Ulcerative keratitis caused by Serratia marcescens after laser in situ keratomileusis
Gonzalo Muñoz1, Jorge L Alió, Juan-José Pérez-Santonja
1Refractive Surgery Department, Instituto Oftalmológico de Alicante, and Division of Ophthalmology, Miguel Hernández University, Alicante, Spain. gon.munoz@terra.es
Abstract:
We report 2 cases of severe corneal infections caused by Serratia marcescens after laser in situ keratomileusis (LASIK). Twenty-four hours after LASIK, 2 patients developed infectious keratitis, 1 bilaterally. In each eye, the corneal flap was edematous, ulcerated, and detached from the stromal bed. Treatment included removal of the necrotic flap and aggressive antibiotic therapy. Cultures from corneal exudates were positive for S marcescens. After 1 year, both patients had a loss of best corrected visual acuity (BCVA) ranging from 20/40 to 20/22 because of irregular astigmatism. Overrefraction with a hard contact lens resulted in a BCVA of 20/20 in the 3 affected eyes. Slitlamp examination showed trace subepithelial haze without severe corneal scarring. Videokeratography disclosed areas of paracentral inferior steepening resembling keratoconus. Refraction and videokeratography remained stable after 6 months of follow-up. Ulcerative keratitis caused by S marcescens is a potential complication of LASIK. Bilateral involvement may occur if bilateral simultaneous surgery is performed.
Insights
Severe Serratia marcescens infections can occur after laser in situ keratomileusis (LASIK) surgery. This can lead to vision loss, but hard contact lenses may restore visual acuity.
Area of Science:
- Ophthalmology
- Microbiology
Background:
- Laser in situ keratomileusis (LASIK) is a common refractive surgery.
- Infectious keratitis is a rare but serious complication following LASIK.
Observation:
- Two patients developed severe infectious keratitis within 24 hours of LASIK.
- Corneal flaps were edematous, ulcerated, and detached.
- Cultures confirmed Serratia marcescens as the causative agent.
Findings:
- Treatment involved flap removal and aggressive antibiotics.
- Patients experienced vision loss (20/40 to 20/22) due to irregular astigmatism.
- Overrefraction with rigid gas permeable contact lenses improved visual acuity to 20/20.
- Videokeratography showed keratoconus-like changes, which remained stable.
Implications:
- Serratia marcescens keratitis is a potential LASIK complication.
- Bilateral involvement is possible with simultaneous bilateral surgery.
- Early diagnosis and treatment are crucial for visual outcomes.
