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Leilani J. Joy, Itza Acevedo, Lilia Rivera, Carmen Santos, Luis Santiago; Diode Laser Phototherapy for Unresponsive Bacterial and Fungal Keratitis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3657. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To report our experience using diode laser phototherapy as adjuvant therapy to medical treatment for unresponsive bacterial and fungal keratitis.
Retrospective case series of two patients with infectious keratitis unresponsive to maximal topical and systemic antibiotic treatment. Both patients were treated with diode laser phototherapy and followed for 10 months. Prior to laser therapy informed consent was obtained, proparacaine 0.5% instilled in eye, and epithelium stained with fluorescein strip. Laser treatment applied to affected corneal tissue using diode 532nm wavelength (Carl Zeiss VISULAS® 532; Meditec, Inc) with spot size of 500mm, pulse duration of 0.1 seconds, and power ranging from 500 to 1500mW titrated until a small cavitation and corneal blanching was achieved.
Case 1, 66-year-old male with 4-month history of mycotic keratitis, culture positive Fonseca Pedrosi, with targeted topical and oral antifungals. Pre-treatment uncorrected visual acuity (UCVA) was 20/100. Improvement in UCVA to 20/50 was observed one month after treatment. Case 2, 52-year-old female with a 4-month history of bacterial keratitis, culture positive to Proteous mirabilis, treated with targeted topical and oral antibiotics. Pre-treatment and post-treatment visual acuity was hand movement at one-month. Complete epithelization and resolution of stromal infiltrate was seen in the first 3 weeks in both cases. There were no recurrences or complications during a 10-month period follow up.
Unresponsive bacterial and mycotic keratitis to medical antibiotic treatment is a significant cause of ocular morbidity. Diode laser phototherapy should be considered as an adjuvant to targeted medical therapy prior to considering more invasive procedures in the acute stage of the infection. Future prospective studies are needed to investigate the safety and efficacy of this treatment modality.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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