Infectious keratitis after corneal crosslinking for keratoconus caused by levofloxacin-resistant microorganisms

Area of Science:

• Ophthalmology
• Microbiology

Background:

• Corneal crosslinking (CXL) is used to slow keratoconus progression.
• Seven cases of infectious keratitis following CXL are presented.

Purpose of the Study:

• To investigate infectious keratitis after corneal crosslinking.
• To identify causative agents and risk factors for post-CXL infections.

Main Methods:

• Retrospective review of 7 patients who developed infectious keratitis after CXL.
• Analysis of CXL protocols (Dresden or accelerated with epithelial removal).
• Microbiological cultures and antibiotic sensitivity testing.

Main Results:

• Infectious keratitis occurred 2-3 days post-CXL, presenting with pain, blurred vision, and inflammation.
• Causative bacteria included methicillin-resistant Staphylococcus aureus, methicillin-sensitive Staphylococcus aureus, and Streptococcus pneumoniae.
• All identified bacteria were resistant to levofloxacin (LVFX).
• Five patients had a history of atopic dermatitis, including four severe cases with hypopyon.

Conclusions:

• There is an increasing incidence of infectious keratitis post-CXL caused by levofloxacin-resistant microbes.
• Close postoperative monitoring is crucial.
• Preoperative conjunctival sac bacterial evaluation via nasal swabs may aid in identifying risks and selecting antibiotics.