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Streptococcus vestibularis atypical infectious keratits after intracorneal ring segment implantation
María Isabel Soler Sanchis1, Lidia Remolí Sargues1, Ramón Calvo Andrés1
1Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain.
Insights
This case report details a rare infection of Streptococcus vestibularis keratitis following intracorneal ring segments (ICRS) implantation for pellucid marginal corneal degeneration. Prompt diagnosis and treatment, including ring removal, were crucial for vision recovery.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Corneal Surgery
Background:
- Intracorneal ring segments (ICRS) implantation is a surgical option for correcting refractive errors in conditions like pellucid marginal corneal degeneration (PMCD).
- Infectious keratitis is a potential, albeit rare, complication following corneal implant procedures.
Observation:
- A 65-year-old male developed infectious keratitis with Streptococcus vestibularis three weeks post-ICRS implantation in his right eye.
- Symptoms included pain, redness, vision loss, and corneal infiltrates along the ring segment, progressing to stromal edema.
Findings:
- Corneal scrapings and cultures from the explanted ring segment identified Streptococcus vestibularis as the causative agent.
- Initial treatment with ciprofloxacin was insufficient, necessitating ring removal and targeted antibiotic therapy with vancomycin and erythromycin.
Implications:
- This case highlights the importance of early recognition and aggressive management of infectious keratitis after ICRS implantation.
- Prompt microbiological investigation, including cultures from explanted devices, and timely surgical intervention are critical to prevent severe visual impairment.
Purpose:
To report the first case of an atypical infectious keratitis caused by Streptococcus vestibularis after ICRS implantation.
Case Report:
A 65-year-old man underwent intracorneal ring segments (ICRS) implantation for the treatment of a pellucid marginal corneal degeneration (PMCD) in his both eyes (OU). Three weeks after the surgery of the right eye (OD), the patient presented with pain, redness, and vision loss in his OD. BCVA was 20/100 Snellen equivalent in the OD. Slit-lamp examination revealed punctate whitish infiltrates along the ring segment with associated corneal stromal edema in the OD. Corneal scrapings were obtained for gram satins and bacterial and fungal cultures, and topical treatment with hourly ciprofloxacin was started. Two days later, corneal stromal edema worsened with involvement of the ring channel. Thus, the ring segment was removed and sent for cultures, and the ring channel was irrigated with vancomycin. Culture from ring segment came back positive for Streptococcus vestibularis, so topical targeted antiobiotherapy with vancomycin and erythromycin was applied. At 3 weeks of follow-up, BCVA was of 20/40 Snellen equivalent in the OD and a subtle corneal leucoma in the OD was observed in the slit-lamp examination.
Conclusion:
Although infectious keratitis is a rare and serious disorder associated with ICRS implantation, its early recognition and management is essential in order to avoid sight-threatening complications. Thus, a prompt obtainment of corneal curettage samples and removal of ring segment becomes decisive to initiate a targeted antiobiotherapy.
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