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Infectious Ulcerative Keratitis Following Retinopathy of Prematurity Treatment
Insights
Infectious ulcerative keratitis is a rare but serious complication following treatment for retinopathy of prematurity (ROP). Postoperative corneal defects can lead to this condition, requiring prompt antibiotic treatment.
Area of Science:
- Ophthalmology
- Neonatal Care
- Infectious Diseases
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
- Laser photocoagulation and pars plana vitrectomy (PPV) are common treatments for ROP.
- Understanding treatment complications is crucial for patient outcomes.
Observation:
- This study reviewed infants treated for ROP between 2004-2013.
- Infectious ulcerative keratitis occurred in 7.27% of treated eyes.
- Corneal epithelial defects preceded keratitis in most cases.
Findings:
- Four neonates (7.27%) developed infectious ulcerative keratitis after ROP treatment.
- Ulcerative keratitis was observed after both laser photocoagulation and PPV.
- Bacterial cultures identified various pathogens, including Staphylococcus and Streptococcus species.
Implications:
- Infectious ulcerative keratitis is a significant complication in ROP treatment.
- Prompt recognition and management of corneal epithelial defects are essential.
- Further research may explore preventative strategies for this complication.
Purpose:
To report the complication of infectious ulcerative keratitis after laser photocoagulation and pars plana vitrectomy (PPV) for retinopathy of prematurity (ROP).
Methods:
A retrospective chart review of infants treated for ROP with plus disease between 2004 and 2013 at University Hospital, Newark, New Jersey.
Results:
Of the 110 eyes (55 patients) that underwent treatment for ROP, 8 (7.27%) eyes were noted to develop infectious ulcerative keratitis in 4 neonates (4 eyes after laser photocoagulation and 4 eyes after PPV). All 8 eyes that developed ulcerative keratitis had a preceding corneal epithelial defect followed by corneal stromal haze. Seven of 8 eyes developed epithelial defect within 8 days of the procedure. All epithelial defects progressed to ulcerative keratitis within 7 days. A total of 10 (9.1%) eyes developed postoperative epithelial defects, and 8 (80%) of these eyes were ultimately diagnosed as having ulcerative keratitis. Four (4.08%) of 98 eyes treated with laser photocoagulation alone developed infective ulcerative keratitis, compared to 4 (33.33%) of 12 eyes treated with PPV. Because keratitis healed, corneal opacification ensued and covered 10% to 90% of the corneal surface area. Five of the 8 eyes had positive culture of corneal scrapings: 2 grew coagulase-negative Staphylococcus and Stenotrophamonas; 1 grew coagulase-negative Staphylococcus; 1 grew Streptococcus viridans, and 1 grew Staphylococcus hominis, Streptococcus mitis, and Streptococcus viridans. All 8 eyes were treated with antibiotic eye drops.
Conclusions:
Infectious ulcerative keratitis developed in a small, but significant, percentage of patients undergoing treatment for ROP. Postoperative corneal epithelial defects with subsequent corneal haze appear to be involved in the progression to ulcerative keratitis.
