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Microbial keratitis after corneal laser refractive surgery.

Daya Papalkar Sharma1, Shanel Sharma, Mark R Wilkins

  • 1Moorfields Eye Hospital, 162 City Rd, London EC1V 2PD, UK. dr.daya.sharma@gmail.com

Future Microbiology
|July 30, 2011
PubMed
Summary
This summary is machine-generated.

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The human eye has a specialized microbiota that reflects its unique anatomical and immunological environment. This low-biomass microbial community predominantly colonizes the conjunctiva and eyelid margins, playing a vital role in ocular surface homeostasis and defense. Despite its proximity to the richly colonized facial skin, the ocular surface maintains a distinct microbial profile due to continuous mechanical and biochemical defense mechanisms.The conjunctival surface hosts fewer microbial...

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Microbial keratitis after corneal laser refractive surgery is rare but sight-threatening. Early diagnosis and specific treatment targeting unusual pathogens are crucial for optimal visual outcomes.

Area of Science:

  • Ophthalmology
  • Microbiology

Background:

  • Corneal laser refractive surgery aims to improve unaided vision in patients with good corrected vision.
  • Microbial keratitis is a rare but potentially sight-threatening complication following refractive surgery.
  • The spectrum of pathogens causing post-refractive surgery keratitis differs from other forms, necessitating a distinct management strategy.

Purpose of the Study:

  • To highlight the unique microbiological challenges in post-refractive surgery keratitis.
  • To emphasize the need for specific diagnostic approaches beyond standard antibiotic coverage.
  • To discuss advanced diagnostic tools for identifying atypical causative organisms.

Main Methods:

  • Review of clinical presentation and management of microbial keratitis post-corneal laser refractive surgery.

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  • Discussion of diagnostic limitations of standard postoperative topical antibiotics (fluoroquinolones).
  • Exploration of diagnostic techniques including lamellar flap lifting for sample acquisition, confocal microscopy, and Polymerase Chain Reaction (PCR).

    • Main Results:

    • Standard postoperative antibiotics may not cover unusual pathogens like fungi, Nocardia, Acanthamoeba, and atypical mycobacteria.
    • Lamellar flap lifting is essential for obtaining samples for specific microbiological examination in suspected cases.
    • Confocal microscopy and PCR show potential for rapid and accurate diagnosis of atypical microbial keratitis.

    Conclusions:

    • Management of microbial keratitis after corneal laser refractive surgery requires a high index of suspicion for atypical organisms.
    • Prompt and specific microbiological diagnosis, including consideration of unusual pathogens, is critical for successful visual recovery.
    • Advanced diagnostic methods like confocal microscopy and PCR can aid in early and accurate identification of causative agents, guiding targeted therapy.