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Bacterial keratitis after radial keratotomy
A Y Matoba1, J Torres, K R Wilhelmus
1Houston Veterans Administration Medical Center, Houston.
Abstract:
The authors identified nine patients with culture-proven keratitis after radial keratotomy (RK). Three patients became infected in the immediate post-operative period, and six patients had delayed-onset keratitis. Gram-negative rods were the predominant pathogens in late-onset keratitis (4 of 6 infections). Gram-positive cocci were implicated in all three postoperative infections. The inferior corneal quadrants were involved in seven of nine patients. Two episodes of late-onset keratitis were associated with contact lens wear. Five of these patients had transverse incisions or greater than eight radial cuts. All six patients regained visual acuity of 20/40 or better. Two additional cases of early-onset and six cases of late-onset keratitis with many features similar to these cases have been reported previously.
Insights
This study investigated keratitis (corneal inflammation) following radial keratotomy (RK) surgery. Most patients recovered good vision, but specific bacterial pathogens and corneal locations were noted in infections after RK.
Area of Science:
- Ophthalmology
- Microbiology
- Surgical Outcomes
Background:
- Radial keratotomy (RK) is a refractive surgical procedure to correct myopia.
- Post-keratotomy infections, such as keratitis, can pose a risk to visual outcomes.
- Understanding the pathogens and clinical presentation of keratitis post-RK is crucial for effective management.
Observation:
- Nine patients with culture-proven keratitis post-RK were identified.
- Infections presented as either immediate post-operative or delayed-onset keratitis.
- Inferior corneal quadrants were the most common site of infection (7/9 patients).
Findings:
- Gram-positive cocci were the primary pathogens in early-onset keratitis.
- Gram-negative rods predominated in delayed-onset keratitis (4/6 cases).
- Contact lens wear was associated with two delayed-onset cases.
- Patients with transverse incisions or >8 radial cuts had higher risk.
Implications:
- Prompt diagnosis and targeted antimicrobial therapy are essential for managing keratitis post-RK.
- Awareness of specific bacterial pathogens based on infection timing can guide treatment.
- Visual acuity was generally good post-treatment, suggesting favorable outcomes with appropriate care.