Acute hydrops with secondary bacterial keratitis: sequelae of paediatric refractive surgery

Area of Science:

• Ophthalmology
• Corneal Surgery
• Refractive Surgery

Background:

• High myopia management often involves complex surgical interventions.
• Pediatric refractive surgery carries potential long-term risks and complications.
• Previous surgeries included bilateral trabeculectomy, photorefractive keratectomy, and radial keratotomy.

Observation:

• A 24-year-old male presented with acute vision loss and eye pain in the right eye.
• Examination revealed central corneal infiltrates with a fluid cleft and 14 radial keratotomy scars.
• Anterior segment OCT confirmed an intrastromal cleft connected to the anterior chamber.

Findings:

• Bacterial culture identified coagulase-negative Staphylococcus as the causative agent.
• The patient received successful treatment with fortified antibiotics tailored to the sensitivity report.
• The corneal infection was linked to previous complex refractive surgical history.

Implications:

• This case emphasizes the need for caution with refractive surgery in children.
• Long-term sequelae of repeated corneal surgeries, including infection, are significant.
• Ophthalmologists should carefully consider risks versus benefits for pediatric refractive surgery and its retreatment.