Infectious Ulcerative Keratitis Following Retinopathy of Prematurity (ROP) Treatment

Abstract

Purpose: To report the complication of infectious ulcerative keratitis after laser photocoagulation and pars plana vitrectomy (PPV) for ROP.

Methods: Retrospective chart review of infants treated for ROP with plus disease, between 2004 and May 2013 at the University Hospital in Newark, NJ.

Results: Of the 110 eyes of 55 patients that had undergone treatment for ROP, 8 eyes (7.27%) were noted to develop infectious ulcerative keratitis; 4 eyes after laser photocoagulation, and 4 eyes after PPV. These were bilateral eyes in 4 patients. All 8 eyes that developed ulcerative keratitis were noted to have preceding epithelial defect (ED) followed by corneal stromal haze. Seven of the 8 eyes that developed keratitis developed ED within 8 days of procedure, and all EDs progressed to ulcerative keratitis within 7 days. A total of 10 of 110 (9.1%) eyes developed post-procedure epithelial defects, 8 (80%) of which progressed to infectious ulcerative keratitis. Upon keratitis healing, corneal opacification was noted in all 8 eyes ranging from 10%-90% of the corneal surface area. Five of the 8 eyes had positive culture of corneal scrapings; 2 eyes grew coagulase-negative Staphylococcus as well as Stenotrophamonas, 1 coagulase-negative Staphylococcus, 1 S. viridans, and 1 S. hominis, S. mitis, and S. viridans. All 8 eyes were managed with fortified antibiotic eye drops.

Conclusions: Infectious ulcerative keratitis develops in a small, but not insignificant percentage of patients undergoing treatment for ROP. Post-operative corneal epithelial defect with subsequent corneal haze appears to be involved in the pathogenesis or disease progression to infectious ulcerative keratitis.

Keywords: 706 retinopathy of prematurity • 573 keratitis • 484 cornea: stroma and keratocytes