Bacterial endophthalmitis resulting from radial keratotomy

Area of Science:

• Ophthalmology
• Microbiology
• Surgical Complications

Background:

• Radial keratotomy is a refractive surgical procedure to correct myopia.
• Corneal perforation is a rare but serious complication during radial keratotomy.
• Endophthalmitis is a severe intraocular inflammation, often caused by bacterial or fungal infection.

Observation:

• A 47-year-old male developed Staphylococcus epidermidis endophthalmitis nine days post-radial keratotomy.
• The patient experienced inadvertent corneal perforation during the 16-incision procedure.
• Clinical signs included anterior chamber reaction, hypopyon, and vitreous inflammation with 'fluffy white balls'.
• Visual acuity was severely reduced to counting fingers at 1 foot.

Findings:

• Staphylococcus epidermidis was identified as the causative agent of endophthalmitis.
• The infection developed secondary to a corneal perforation during radial keratotomy.
• Aggressive management, including pars plana vitrectomy and comprehensive antibiotic administration, was initiated.

Implications:

• This case highlights the risk of endophthalmitis following inadvertent corneal perforation during refractive surgery.
• Multimodal antibiotic therapy (intraocular, periocular, intravenous, topical) combined with surgical intervention is crucial for managing post-surgical endophthalmitis.
• Successful visual recovery to 6/9 (20/30) demonstrates the efficacy of prompt and aggressive treatment in sight-threatening conditions.