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Samar A Al-Swailem, Mohanna AL-Jindan; Outcome of Late-onset Keratitis Complicating the Implantation of Intrastromal Corneal Ring Segments. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2830.
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To report risk factors, clinical course, and outcome of keratitis following implantation of intrastromal corneal ring segments (ICRS).
The records of all (n= 628) eyes which underwent implantation of ICRS (INTACS, Keraring) plus those referred to our largest tertiary eye hospital in the country with keratitis after ICRS implantation, were reviewed retrospectively.
Keratitis developed in 12 eyes (9 men and 3 women), 11 (1.75%) of which were operated locally with a mean age of 27 years and onset ranging from 4 to 10 months postoperatively. Epithelial defect (50%), non- Femtosecond assisted implantation technique (67%), absent suture at incision (70%), hypopyon (16.7%) and exposed ICRS (8%) were factors associated with keratitis. Presenting symptoms at a mean of 1.5 days, included pain (n=12), red eyes (n=12) and purulent discharge (n=2). Culture were positive (n=8) for Staphylococcus (n=3), Streptococcus (n=2), Propionibacterium (n=2) and candida (n=1). Management included topical antibiotics (n=12), topical steroid (n=11), systemic antibiotics (n=2), Intra-tunnel antibiotic injection (n=1), ICRS explantation (n=11) and patch graft (n=2). After a mean of 14 days therapy, keratitis slowly resolved, leaving scar (n=8), neovascularization (n=1) and a mild deterioration of median best corrected visual acuity from 20/50 prior to infection to 20/60.
Keratitis is uncommon complication after ICRS implantation. Although most of these cases present in the early postoperative period, late occurrence was predominant in our patients. Early recognition, rapid use of broad-spectrum antibiotics, and early explantation may prevent sight-threatening complications and result subsequently in a better visual outcome.
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