Infectious Keratitis after Photorefractive Keratectomy in the United States Army and Navy

Authors

Keith J. Wroblewski, Kimbrough Army Hospital
Joseph F. Pasternak, Walter Reed National Military Medical Center
Kraig S. Bower, Walter Reed National Military Medical Center
Steven C. Schallhorn, Naval Medical Center San Diego
Walter J. Hubickey, Womack Army Medical Center
Cary E. Harrison, Naval Hospital Jacksonville
Mark F. Torres, Madigan Army Medical Center
Scott D. Barnes, Womack Army Medical Center

Document Type

Journal Article

Publication Date

4-1-2006

Journal

Ophthalmology

Volume

113

Issue

4

DOI

10.1016/j.ophtha.2005.09.038

Abstract

Purpose: To review the incidence, culture results, clinical course, management, and visual outcomes of infectious keratitis after photorefractive keratectomy (PRK) at 6 Army and Navy refractive surgery centers. Design: Retrospective study. Participants: Twelve thousand six hundred sixty-eight Navy and Army sailors and service members. Methods: Army and Navy refractive surgery data banks were searched for cases of infectious keratitis. A retrospective chart review and query of the surgeons involved in the care of those patients thus identified provided data regarding preoperative preparation, perioperative medications, treatment, culture results, clinical course, and final visual acuity. Results: Between January 1995 and May 2004, we performed a total of 25337 PRK procedures at the 6 institutions. Culture proven or clinically suspected infectious keratitis developed in 5 eyes of 5 patients. All patients received topical antibiotics perioperatively. All cases presented 2 to 7 days postoperatively. Cultures from 4 cases grew Staphylococcus, including 2 methicillin-resistant S. aureus (MRSA). One case of presumed infectious keratitis was culture negative. There were no reported cases of mycobacterial or fungal keratitis. In addition, we identified 26 eyes with corneal infiltrates in the first postoperative week that were felt to be sterile, and which resolved upon removal of the bandage contact lens and increasing antibiotic coverage. Conclusions: Infectious keratitis is a rare but potentially vision-threatening complication after PRK. It is often caused by gram-positive organisms, including MRSA. Early diagnosis, appropriate laboratory testing, and aggressive antimicrobial therapy can result in good outcomes. © 2006 American Academy of Ophthalmology.

APA Citation

Wroblewski, K., Pasternak, J., Bower, K., Schallhorn, S., Hubickey, W., Harrison, C., Torres, M., & Barnes, S. (2006). Infectious Keratitis after Photorefractive Keratectomy in the United States Army and Navy. Ophthalmology, 113 (4). http://dx.doi.org/10.1016/j.ophtha.2005.09.038