Clinical Analysis of Infectious Keratitis after LASIK

ABSTRACT

PURPOSE: To improve the understanding of infectous keratitis after LASIK by analyzing our clinical experiences. METHODS: We retrospectively reviewed the records of 12 eyes of 9 subjects who developed infectious keratitis after LASIK, and compared them in terms of onset of symptoms, microbiologic profile, medical and surgical interventions, and final visual acuities. RESULTS: Among them, one eye was found to have culture-proven bacterial infection, five eyes with non tuberculous mycobacterial infection, one eye with Nocardial infection, one eye with fungal keratitis and four eyes of two subjects with unisolated microorganisms. Bacterial infections included unisolated cases presenting 2 days after LASIK, mycobacteria presented at an average of 14.4 days after LASIK, Nocardia presented 4 months after LASIK (7 days after trauma), and fungus presented 3 days after LASIK. Bacterial infections were diagnosed immediately after onset of symptoms, and resolved 30 days after treatment. Mycobacterial infections were diagnosed 14 days (6-55 days) after onset and resolved after 6.2 months of treatment, which included flap amputation in 4 of 5 eyes. Fungal infections were diagnosed 30 days after onset, and resolved after 2.5 months of treatment. Norcardial infections were diagnosed 17 days after onset, and resolved after 3 months. Final visual acuities were over 0.5 in 4 of 5 cases of bacteria, in 3 of 5 cases of mycobacteria, in the 1 case of Nocardia and light perception in fungal keratitis. CONCLUSIONS: Bacterial infections tended to present within two days, whereas mycobacteria presented about 14 days after LASIK. Mycobacterial infections required the longest duration of treatment, however the visual outcome was the worst in fungal keratitis.