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Infections after PRK could have a happy ending: a series of three cases
D R Bertschinger1, K Hashemi, F Hafezi
1Hôpital Ophtalmique Jules-Gonin, Faculté de Médecine de Lausanne, Lausanne, Switzerland.
Background:
Infectious keratitis after PRK remains a rare but potentially devastating complication.
History And Signs:
Medical records of 3 male patients with infectious keratitis after uneventful PRK for myopia and astigmatism were reviewed retrospectively. PRK was performed using the Wavelight Allegretto excimer laser. Postoperative care included a bandage contact lens (BCL) for 5 days, topical antibiotics, ketorolac, and artificial tears.
Therapy And Outcome:
Keratitis presented 2 - 4 days postoperatively. In one case, each culture was negative (case 1), and was positive for Streptococcus pneumoniae (case 2) and Staphylococcus aureus (case 3). Final BSCVA (best spectacle corrected visual acuity) after intensive antibiotic treatment and removal of BCL were 1.0 (case 1), 0.9 (case 2) and 0.3 correctable to 0.8 with pinhole (case 3).
Conclusions:
Postoperative broad-spectrum antibiotics are mandatory after PRK to prevent infectious keratitis. However, resistant organisms are more and more common. The presence of a bandage soft contact lens after surgery is an unfavourable element that may increase risk of infection. Based on our case series, we suggest limiting soft contact lens wear during the two postoperative days even if the corneal ulceration is not healed.
Insights
Infectious keratitis after photorefractive keratectomy (PRK) can be severe. Limiting bandage contact lens wear post-PRK may reduce infection risk, even with developing antibiotic resistance.
Area of Science:
- Ophthalmology
- Microbiology
Background:
- Infectious keratitis is a rare but serious complication following photorefractive keratectomy (PRK).
- This study investigates three cases of infectious keratitis after uneventful PRK for myopia and astigmatism.
Observation:
- Patients presented with keratitis 2-4 days postoperatively.
- Cultures identified Streptococcus pneumoniae and Staphylococcus aureus in two cases; one culture was negative.
- Postoperative care included bandage contact lenses (BCL), antibiotics, ketorolac, and artificial tears.
Findings:
- Visual acuity varied significantly post-treatment, with best spectacle corrected visual acuity (BSCVA) ranging from 0.3 to 1.0.
- Intensive antibiotic treatment and BCL removal were part of the management.
- The presence of a BCL was identified as a potential risk factor for infection.
Implications:
- Broad-spectrum antibiotics are crucial post-PRK to prevent infectious keratitis.
- Increasing antibiotic resistance necessitates careful management strategies.
- Reducing bandage contact lens wear duration in the early postoperative period may mitigate infection risk.
