Download 2005.07.14- Diminished Color Vision

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
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1
SCHOOL OF MEDICINE
Introduction
• Infectious
keratitis
after
refractive surgery procedures,
is a rare (less than 1/1000
surgeries),
but
sightthreatening 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
UNIVERSITY OF
2
SCHOOL OF MEDICINE
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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3
SCHOOL OF MEDICINE
Methods
Review of the medical records from all
patients
with
culture-proven
postrefractive surgery infectious keratitis and
treated at the Bascom Palmer Eye
Institute from July 2001 through
December 2007 was performed
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4
SCHOOL OF MEDICINE
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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7
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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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8
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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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9
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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
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