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T. Ryan, I. J. Udell, J. Primack; Epidemic Keratoconjunctivitis in Refractive Surgery Patients. Invest. Ophthalmol. Vis. Sci. 2007;48(13):760.
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To evaluate the clinical characteristics of EKC (epidemic keratoconjunctivitis) among refractive surgery patients.
Retrospective chart review was performed on 8 patients (15 eyes) diagnosed with EKC during a month-long outbreak at a university-affiliated ophthalmology practice. 5 patients were status post PRK, 3 were status post LASIK. Main outcome measures were (1) presence and description of corneal infiltrates, (2) visual acuity decline and recovery.
Median follow-up was 8 months. Mean age at diagnosis was 37 years (range 24 - 67). 100% of patients developed corneal SEIs (sub-epithelial infiltrates). SEIs persisted in all patients at last follow-up exam, despite treatment of 6 patients (75%) with topical steroids. SEIs were characterized as "typical" in all 3 LASIK patients. One LASIK patient developed monocular interface haze. Among PRK patients, SEIs were characterized as "typical" in 2 patients and as "diffuse" or "granular" in 3 patients. On average, visual acuity declined 4 lines, ranging from 20/20 to 20/60 before infection (best uncorrected visual acuity), to a range of 20/40 to 20/800 after infection (worst uncorrected visual acuity). 100% of patients recovered greater than or equal to 20/50 visual acuity at last follow-up exam.
After a diagnosis of EKC, refractive surgery patients had a significant decline in their vision, with good recovery of visual acuity after treatment. However, although not assessed in this study, persistence of SEIs after prolonged follow-up may affect higher order visual function. SEIs were described as diffuse or granular in the majority of PRK patients studied, suggesting that the destruction of Bowman's layer may affect the clinical course of infiltrates in PRK patients.
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