Infections after refractive surgery

Infectious Keratitis After Keratorefractive Surgery: Update and Review of the Literature

OBJECTIVES

To summarize the clinical manifestations, microbiological profile, treatment, and prognosis of corneal infections after different keratorefractive surgery.

METHODS

To obtain relevant studies, English-language databases, including PubMed, Ovid Embase, Web of Science, and CLNAHL, were searched from January 1979 to March 2022. The fundamentals of the literature, clinical characteristics, pathogens, and treatments were retrieved for each included article.

RESULTS

Eighty-four studies involving 306 infectious eyes were included in this review. Risk factors of potential infection included a history of blepharitis, contact lens usage, and contaminated surgical instruments. The mean onset time was 22.9±38.7 days (range: 1 day to 3 years). The most common organism isolated from infectious keratitis after keratorefractive surgery were Staphylococcus aureus , followed by Mycobacterium and coagulase-negative Staphylococcus . Most of the infections after refractive procedures were sensitive to medical treatment alone, and the ultimate best-corrected visual acuity after medical treatment was as follows: 20/20 or better in 82 cases (37.0%), 20/40 or better in 170 cases (76.5%), and worse than 20/40 in 52 cases (23.5%). Surgical interventions including flap lift, flap amputation, ring removal, and keratoplasty were performed in 120 eyes (44.5%).

CONCLUSIONS

Most infections after keratorefractive surgery occur within a week, whereas more than half of the cases after laser-assisted in situ keratomileusis happen after about a month. Gram-positive cocci and mycobacterium are the most common isolates. Infections after LASIK, intracorneal ring (ICR) implantation, and small incision lenticule extraction, which primarily occur between the cornea layers, require irrigation of the tunnels or pocket with antibiotics.

Clinical Outcomes of Applying Therapeutic Contact Lenses and Eye Drops after Cataract Surgery

Purpose: To investigate the safety of applying therapeutic contact lenses and eye drops after cataract surgery.Methods: Immediately after cataract surgery, 947 eyes (group 1) used therapeutic contact lenses and eye drops and 914 (group 2) applied antibiotic ointment and wore a gauze eye patch for the first postoperative day. Clinical outcomes including best corrected visual acuity (BCVA), IOP, degree of anterior chamber inflammation, wound leakage, and postoperative endophthalmitis were compared in the two groups 1 day, 1 week, and 1 month after surgery.Results: There were no significant differences in the mean pre- and postoperative BCVA and IOP at 1 day, 1 week, and 1 month between groups 1 and 2. There was no difference in anterior chamber inflammation between the two groups at 1 day (p = 0.302), 1 week (p = 0.437), or 1 month (p = 0.960) after surgery. On the first postoperative day, 10 eyes in group 1 and nine eyes in group 2 had wound leakage (p = 1.000). There was no endophthalmitis in either group.Conclusions: The risk of postoperative complications in group 1 was not higher than in group 2. Therefore, wearing therapeutic contact lenses and using eye drops is a relatively safe management method after cataract surgery.

Postrefractive infectious keratitis: prevention, diagnosis, management, and prognosis

PURPOSE OF REVIEW

Improve outcomes from an elective procedure by preventing a rare but sight-threatening complication.

RECENT FINDINGS

Advancement in anti-infective prophylaxis, and therefore shift in the causative organism permits better diagnostic and empiric management.

SUMMARY

Infectious keratitis presents in different patterns depending on the refractive procedure. Atypical causative organisms may respond poorly to empiric therapy and impair vision. Therefore, microbial identification is of utmost importance and therapy is adjusted accordingly.

Keratitis following laser refractive surgery: Clinical spectrum, prevention and management

Laser refractive surgery (LRS) is one of the most demanding areas of ophthalmic surgery and high level of precision is required to meet outcome expectations of patients. Post-operative recovery is of vital importance. Keratitis occurring after LRS can delay visual recovery. Both surface ablations [Photorefractive keratectomy (PRK)] as well as flap procedures [Laser in-situ keratomileusis (LASIK)/Small incision lenticule extraction] are prone to this complication. Reported incidence of post-LRS infectious keratitis is between 0% and 1.5%. The rate of infections after PRK seems to be higher than that after LASIK. Staphylococci, streptococci, and mycobacteria are the common etiological organisms. About 50–60% of patients present within the first week of surgery. Of the non-infectious keratitis, diffuse lamellar keratitis (DLK) is the most common with reported rates between 0.4% and 4.38%. The incidence of DLK seems to be higher with femtosecond LASIK than with microkeratome LASIK. A lot of stress is laid on prevention of this complication through proper case selection, asepsis, and use of improved protocols. Once keratitis develops, the right approach can help resolve this condition quickly. In cases of suspected microbial keratitis, laboratory identification of the organism is important. Most lesions resolve with medical management alone. Interface irrigation, flap amputation, collagen cross-linking and therapeutic penetrating keratoplasty (TPK) are reserved for severe/non-resolving cases. About 50–75% of all infectious keratitis cases post LRS resolve with a final vision of 20/40 or greater. Improved awareness, early diagnosis, and appropriate intervention can help limit the damage to cornea and preserve vision.

Bibliometric and visualized analysis of global research on fungal keratitis from 1959 to 2019

BACKGROUND

Fungal keratitis is one of the leading causes of ocular morbidity. The prognosis of fungal keratitis is poorer than many other forms of keratitis but the research of which relatively lags behind. We conducted a bibliometric and visualized analysis in order to characterize the overall status, general trends and current foci of keratomycosis research field.

METHODS

Literature database ranged from 1959 to 2019 was obtained from web of science core collection and analyzed by Citespace and VOSviewer software.

RESULTS

A total of 1906 papers of fungal keratitis were retrieved and derived a 27,917 references document set. The number of publications increased rapidly in past 30 years. Cornea was the journal published most papers of keratomycosis. The leading countries were United States of America (USA), India and Peoples Republic of China (PRC), from where came the most productive and most cited institutions and authors. Co-cited reference analysis revealed the most cited manuscripts were concerned about epidemiology or spectrum. Lens-associated Fusarium, amphotericin B, voriconazole, corneal cross-linking, predisposing factor are some of the high frequency topics in clustered co-cited reference analysis and co-occurrence keywords analysis. Burst detection analysis of keywords showed ocular drug delivery was the new research foci.

CONCLUSION

From this study, we received an overall view to the current status, trends and hot spots of fungal keratitis research field. Visualized bibliometric analysis is an efficient way for literature learning and useful for future researchers.

Post laser-assisted in situ keratomileusis keratomycotic malignant glaucoma

We report a case of a 24-year-old male patient with post-laser assisted in situ keratomileusis (LASIK) culture-proven mycotic keratitis who developed pupillary block glaucoma on day 19 of medical management. The case was initially managed with multiple Nd-Yag peripheral iridotomy along with systemic and topical antiglaucoma medications. However, an emergency therapeutic penetrating keratoplasty (TPK) with lens extraction was done in view of persistently raised intraocular pressure (IOP) and seclusio pupillae. On postoperative day 1, IOP was 10 mm Hg with graft clarity 2 plus and deep anterior chamber with no evidence of residual infection or recurrence. Pupillary block glaucoma can occur in cases of post-LASIK mycotic keratitis, which may necessitate emergency TPK.