Rafael A. Oechsler, MD 1,2

1
Update on Infectious Keratitis after Refractive
Surgery

• Rafael A. Oechsler, MD 1,2
• Alfonso Iovieno, MD 1
• Darlene Miller, DHSc, MPH 1
• Eduardo Alfonso, MD 1

1 - Bascom Palmer Eye Institute Miller School
of Medicine University of Miami 2 -
Ophthalmology Department - Federal University of
Sao Paulo - Brazil
None of the authors has any financial interest on
the contents of this study
2
Introduction

• Infectious keratitis after refractive surgery
  procedures, is a rare (less than 1/1000
  surgeries), but sight-threatening condition.
• Risk factors include lack of sterility during the
  procedure and predisposing factors inherent of
  each patient, such as dry eye, blepharitis and
  delayed epithelial healing.

Trichosporon spp infection post-LASIK
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Purpose

• To report clinical aspects and outcomes of
  culture-proven post-refractive surgery infectious
  keratitis in patients treated at the Bascom
  Palmer Eye Institute from July 2001 through
  December 2007

Mycobacteria (MOTT) infection post-LASIK
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Methods

• Review of the medical records from all patients
  with culture-proven post-refractive surgery
  infectious keratitis and treated at the Bascom
  Palmer Eye Institute from July 2001 through
  December 2007 was performed

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Results Demographics

• 12 eyes in 10 patients
• 7 males (70) and 3 females (30)
• Mean age 42 years (range 23-65 years)
• Mean follow-up time was 22 months (range 2-45
  months)

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Results main clinical outcomes
BCVA Initial LogMAR 1.0 (20/200) Final LogMAR 0.55 (20/70)
Infiltrate size 4mm Range 1-8mm
Time to cure 74 days Range 25-170 days
Therapeutic keratoplasty 6 eyes (50) 4 in MOTT infections 2 in mold infections
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Results Pathogens
Nontuberculous Mycobacteria (MOTT) (42) 5 eyes
Yeasts (25) 2 Candida spp 1 Trichosporon spp
Molds (17) 1 Aspergillus spp 1 Acremonium spp
S. aureus (17) 1 MSSA 1 MRSA
MRSA infection post-LASIK
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Results Medications

• Topical medications when seen
• 5 eyes on 4th generation fluoroquinolones
  (Moxifloxacin, Gatifloxacin)
• 4 eyes on 2nd generation fluoroquinolones
  (Ciprofloxacin, Oxifloxacin)
• 2 eyes on Vancomycin 5 Tobramycin 1.4
• 1 eye on Natamycin 5 Vanco 5 Tobra 1.4

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Results Risk Factors

• 3 eyes trauma (foreign body)
• 1 eye enhancement
• 1 eye previous Radial Keratotomy (RK)
• 7 eyes none

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Conclusions

• Even after the start of use of 4th generation
  fluoroquinolones, Mycobacteria continue to be the
  most frequent pathogen associated with
  post-refractive surgery infections.
• Fungi had an increased incidence (42) when
  compared with our last study (20)

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Conclusions

• The rate of therapeutic therapeutic
  keratoplasties is very high (50) among these
  patients.
• All molds (2 out of 2) and 80 of the MOTT (4 out
  of 5) required a therapeutic PK
• None of the yeasts or S. aureus cases required a
  PK