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Related Experiment Videos

Fourth-generation fluoroquinolone-resistant bacterial keratitis after refractive surgery.

Majid Moshirfar1, Garen Mirzaian, Vahid Feiz

  • 1John A. Moran Eye Center, Department of Ophthalmology, University of Utah, Salt Lake City, Utah 84132, USA.

Journal of Cataract and Refractive Surgery
|April 25, 2006
PubMed
Summary
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Two cases of bacterial keratitis resistant to fourth-generation fluoroquinolones were observed after LASIK and PRK eye surgeries. This highlights potential limitations of these antibiotics, necessitating alternative treatments like aminoglycosides.

Area of Science:

  • Ophthalmology
  • Microbiology
  • Infectious Diseases

Background:

  • Fourth-generation fluoroquinolones are commonly used for prophylaxis and treatment of ocular infections after refractive surgery.
  • Laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) are common refractive surgical procedures.

Observation:

  • Two patients developed bacterial keratitis post-refractive surgery despite antibiotic prophylaxis.
  • The first patient had Pseudomonas aeruginosa keratitis after PRK, unresponsive to moxifloxacin.
  • The second patient developed methicillin-resistant Staphylococcus aureus (MRSA) keratitis post-LASIK while on gatifloxacin.

Findings:

  • Culture and susceptibility testing revealed bacterial isolates resistant to moxifloxacin and gatifloxacin in both cases.

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  • Treatment required topical aminoglycosides and surgical intervention for successful outcomes.
  • These cases represent the first reported instances of fluoroquinolone-resistant keratitis after LASIK and PRK.

    • Implications:

    • The findings suggest a potential rise in fluoroquinolone resistance in ocular pathogens following refractive surgery.
    • Clinicians should consider antibiotic susceptibility testing for persistent or severe post-operative keratitis.
    • Alternative or combination antibiotic therapies may be necessary to manage resistant bacterial keratitis effectively.