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Published on: July 6, 2015
Infections following laser in situ keratomileusis: an integration of the published literature
Margaret A Chang1, Sandeep Jain, Dimitri T Azar
1Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Abstract:
Infections occurring after laser in situ keratomileusis (LASIK) surgery are uncommon, but the number of reports have steadily increased in recent years. This systematic, comprehensive review and analysis of the published literature has been performed in order to develop an integrative perspective on these infections. We have stratified the data by potential associations, microbiology, treatment, and the degree of visual loss, using Fisher's exact tests and Student's t-tests for analysis. In this review, we found that Gram-positive bacteria and mycobacterium were the most common causative organisms. Type of postoperative antibiotic and steroid use was not associated with particular infecting organisms or severity of visual loss. Gram-positive infections were more likely to present less than 7 days after LASIK, and they were associated with pain, discharge, epithelial defects, and anterior chamber reactions. Fungal infections were associated with redness and tearing on presentation. Mycobacterial infections were more likely to present 10 or more days after LASIK surgery. Moderate or severe visual reductions in visual acuity occurred in 49.4% of eyes. Severe reductions in visual acuity were significantly more associated with fungal infections. Flap lift and repositioning preformed within 3 days of symptom onset may be associated with better visual outcome.
Insights
Post-LASIK infections, though rare, are increasing. Gram-positive bacteria and mycobacteria are common causes, with fungal infections linked to severe vision loss. Early flap repositioning may improve outcomes.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Surgical Outcomes
Background:
- Infections following laser in situ keratomileusis (LASIK) are uncommon but increasing.
- A comprehensive review is needed to understand LASIK-associated infections.
Purpose of the Study:
- To analyze published literature on post-LASIK infections.
- To identify common pathogens, risk factors, and visual outcomes.
- To evaluate treatment strategies and their effectiveness.
Main Methods:
- Systematic review and analysis of published literature.
- Stratification of data by microbiology, treatment, and visual loss.
- Statistical analysis using Fisher's exact tests and Student's t-tests.
Main Results:
- Gram-positive bacteria and mycobacteria were the most common pathogens.
- Fungal infections were associated with severe visual reduction.
- Early flap lift and repositioning (within 3 days) may correlate with better visual outcomes.
- 49.4% of eyes experienced moderate to severe visual acuity reduction.
Conclusions:
- Understanding causative organisms and timelines is crucial for managing post-LASIK infections.
- Prompt intervention, including flap repositioning, may mitigate visual loss.
- Further research into preventative strategies and targeted treatments is warranted.
