ABSTRACT
PURPOSE: To report a patient with an initial presentation of optic disk edema secondary to Propionibacterium acnes endophthalmitis. METHODS: Interventional case report. The patient had surgery and treatment related to endophthalmitis. Nine months after cataract surgery with posterior chamber lens implant, a 79-year-old man receiving topical corticosteroids in the same eye presented with best-corrected visual acuity of 20/60, a superior visual field defect, and optic nerve edema without intraocular inflammation. One year postoperatively, the eye presented a further decrease in best-corrected visual acuity, and a dense white plaque was noted on the posterior capsule. RESULTS: One year postoperatively, a partial capsulectomy with vitrectomy and injection of intravitreal antibiotics was performed. Hematoxylin and eosin stain of the posterior capsule plaque revealed gram-positive coccobacilli characteristic of P. acnes. CONCLUSION: Propionibacterium acnes endophthalmitis may present after cataract surgery with intraocular lens implant with decreased vision, optic disk edema, and a visual field defect.
Subject(s)
Endophthalmitis/diagnosis , Eye Infections, Bacterial/diagnosis , Gram-Positive Bacterial Infections/diagnosis , Papilledema/diagnosis , Propionibacterium acnes/isolation & purification , Aged , Anti-Bacterial Agents , Combined Modality Therapy , Drug Therapy, Combination/therapeutic use , Endophthalmitis/microbiology , Endophthalmitis/therapy , Eye Infections, Bacterial/microbiology , Eye Infections, Bacterial/therapy , Gram-Positive Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/therapy , Humans , Lens Capsule, Crystalline/microbiology , Lens Implantation, Intraocular/adverse effects , Male , Papilledema/microbiology , Phacoemulsification/adverse effects , Visual Acuity , VitrectomyABSTRACT
PURPOSE: To report two cases of infectious keratitis, one fungal after photorefractive keratectomy (PRK) and the other bacterial after laser in situ keratomileusis (LASIK). DESIGN: Two interventional case reports. PARTICIPANTS: Case 1 is a male who was seen 3 weeks after PRK with a corneal ulceration. Case 2 involves a female who was seen 7 weeks after LASIK with interface granularity. RESULTS: Cultures in case 1 were identified as Scopulariopsis species, and despite intensive treatment, a therapeutic penetrating keratoplasty (PK) was eventually performed. Case 2 had cultures identified as Mycobacterium chelonae and also ultimately required a therapeutic PK. CONCLUSIONS: Two unusual infectious keratitides are reported after different laser refractive surgery techniques.
Subject(s)
Ascomycota/isolation & purification , Eye Infections/microbiology , Keratitis/microbiology , Keratomileusis, Laser In Situ/adverse effects , Mycobacterium Infections, Nontuberculous/microbiology , Mycobacterium chelonae/isolation & purification , Mycoses/microbiology , Adult , Cornea/microbiology , Cornea/surgery , Eye Infections/diagnosis , Eye Infections/surgery , Female , Humans , Keratitis/diagnosis , Keratitis/surgery , Keratoplasty, Penetrating , Male , Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium Infections, Nontuberculous/surgery , Mycoses/diagnosis , Mycoses/surgery , Refractive Surgical ProceduresABSTRACT
OBJECTIVE: To evaluate the relationship between predicted flap thickness and actual flap thickness and between predicted tissue ablation and actual tissue ablation. DESIGN: Prospective, nonrandomized comparative (self-controlled) trial. PARTICIPANTS: A total of 60 patients (102 eyes) who underwent laser in situ keratomileusis (LASIK). MAIN OUTCOME MEASURES: Subtraction pachymetry was used to determine actual corneal flap thickness and corneal tissue ablation depth. Other measurements included flap diameter and keratometry readings. RESULTS: Actual flap thickness was significantly different (P < 0.0001) from predicted flap thickness. Fifteen eyes had a predicted flap thickness of 160 micrometer and a mean actual flap of 105 micrometer (standard deviation [SD], +/-24. 3 micrometer range, 48-141 micrometer). Sixty-four had a predicted flap of 180 micrometer with an actual flap mean of 125 micrometer (SD, +/-18.5 micrometer range, 82-155 micrometer). Seventeen eyes had a predicted flap of 200 micrometer, with an actual flap mean of 144 micrometer (SD, +/-19.3 micrometer range, 108-187 micrometer). In addition, we found that significantly more tissue (P < 0.0001) was ablated than predicted. Linear regression of the observed ablation on predicted ablation yielded the following relationship: actual ablation = 14.5 + 1.5 (predicted ablation). Neither flap diameter nor flap thickness were found to increase with respect to steeper corneal curvatures. CONCLUSIONS: Actual corneal flap thickness was consistently less than predicted regardless of the depth plate used; actual tissue ablation was consistently greater than predicted tissue ablation for the laser used in this study.
