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Megan Law, Stephen D McLeod, Steve Schallhorn, Julie Marie Schallhorn; Late Onset Infectious Keratitis after Laser in situ Keratomileusis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3880.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the clinical course and outcomes of patients with late onset microbial keratitis (MK) after laser in situ keratomileusis (LASIK).
We retrospectively reviewed the records of LASIK patients who developed corneal infiltrates greater than 1 month after surgery between July 2009 to August 2016 from two centers (Optical Express, Glasgow, UK and the University of California San Francisco). We noted the patient’s age, eye laterality, pre-operative manifest refraction, potential risk factors for the development of MK, interval time between LASIK and the development of infiltrates, complications following LASIK, treatment course, and final visual acuity.
We identified eight patients with delayed onset corneal infiltrates. The mean age of the patients was 47.8 years (range: 32 to 63 years), and the average time after surgery to presentation was 44.75 months (range: 1.5 to 192 months). Four wore bandage contact lens for the treatment of surface disease when they presented with infiltrates. Three patients had enhancement procedures 6-48 months prior to developing infiltrates. Five underwent corneal cultures (two with flap lifting); none of these were culture-positive. Five of six patients received aggressive topical antibiotics and were diagnosed with presumed MK, while one patient was referred for treatment elsewhere. After improvement of infiltrates, these patients were started on aggressive topical steroids to treat interface flap inflammation. One patient presented with an infiltrate that was suspicious for an infectious vs inflammatory process, and was successfully treated with topical steroids alone. Final best spectacle corrected acuity was 20/20 in 4/6 patients for whom extended follow up was available (range 20/20 to 20/80). One patient required a corneal graft post-treatment for visual rehabilitation. Two patients had subsequent epithelial ingrowth, one of which required flap lifting 10 months after treatment for MK.
Although uncommon, delayed infectious keratitis after LASIK can occur. Contact lens wear seems to be a risk factor. Successful treatment requires addressing the infectious process as well as the inflammation induced by the infection. For patients whom follow up was available, the majority had a good visual outcome. Epithelial ingrowth is a potential complication after infectious keratitis unique to the post-LASIK population.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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