[Infectious corneal ulcers--once with endophthalmitis--after photorefractive keratotomy with disposable contact lens]

Infections of the cornea with or without involvement of intraocular tissues are severe complications after photorefractive keratectomy. We report on three cases with ulcerative keratitis and one case with severe endophthalmitis, which developed some days after laser treatment.

After 39 photo-therapeutic and 118 photo-refractive treatments without complications four young treated persons suffered from corneal infiltrations. Three of them developed severe corneal ulcerations, one a severe endophthalmitis. We used the laser machine of the company Schwind (193 nm wavelength, repetition rate 10 Hz, fluence 180-200 mJ/cm2). One part of the treatment which all patients had in common was the application of a disposable contact lens postoperatively, which was worn overnight. THERAPY AND FOLLOW-UP: Because all three patients with ulcerations revealed hyphen of fungi in their corneal-scratch material they were treated with antifungal agents locally and systemically. Due to the local and temporal connection the patient with the endophthalmitis was treated with antifungal agents, too. All corneal ulcerations healed with scars similar to a haze graded 3 to 4, the eye with the endophthalmitis healed almost completely.

Probably the use of disposable contact lenses postoperatively, especially the overnight wear, during an extremely hot and humid summer lead to the described severe infections of the eyes after the "traumatisation" of the cornea by the excimer laser. A known higher concentration of Aspergillus in the air due to renovations of buildings in the clinical area might have been an additional negative effect. The avoidance of the use of disposable contact lenses postoperatively, especially the overnight wear, is emphasized.