1/9. Bacterial keratitis following laser in situ keratomileusis for hyperopia.A 42-year-old Bahraini man had uneventful laser in situ keratomileusis for hyperopia (OD: 3.00 0.75 x 155 degrees; OS: 2.00 0.50 x 155 degrees). Three weeks later, he presented with localized keratitis in his right eye, with localized keratitis at the flap margin with stromal edema. Uncorrected visual acuity was 20/80 OD with no improvement with pinhole, and was 20/20 OS. Corneal smear culture showed a positive growth of staphylococcus aureus. The patient was immediately treated with subconjunctival gentamicin and intensive topical ofloxacin 0.3% with systemic cephalosporin. The patient recovered from keratitis within 2 weeks and his uncorrected visual acuity OD improved to 20/20. keratitis following LASIK should be treated promptly so that it does not lead to permanent reduction in visual acuity.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
2/9. Traumatic acremonium atrogriseum keratitis following laser-assisted in situ keratomileusis.A 52-year-old man underwent bilateral laser-assisted in situ keratomileusis. Eight months later, he sustained a penetrating corneal injury to the left eye. A dense white infiltrate, unresponsive to antimicrobial therapy, developed in the corneal stroma. Corneal biopsy and eventual penetrating keratoplasty were performed, and both specimens demonstrated fungal elements with branching, septate hyphae. culture identified the organism as acremonium atrogriseum. Histopathologic features of this organism and its differentiation from other, more common fungal organisms are discussed herein.- - - - - - - - - - ranking = 0.57142857142857keywords = keratitis (Clic here for more details about this article) |
3/9. Central necrotic lamellar inflammation after laser in situ keratomileusis.PURPOSE: To report four cases of corneal interface complications that occurred after excimer laser in situ keratomileusis (LASIK). methods: Four eyes of three patients underwent technically uneventful LASIK. RESULTS: One day after LASIK, patients presented with severe pain, blurred vision, conjunctival infection, and diffuse opacity at the interface. Two days after LASIK, significant features were central opacity, striae in the flap, loss of uncorrected and best spectacle-corrected visual acuity, and corneal sensitivity. The findings did not improve by using drugs or by lifting the flap and irrigating the bed. The central opacity partially resolved over 8 to 12 months, leaving a hyperopic shift (one patient), striae (one patient), and loss of two or more lines of best spectacle-corrected visual acuity (three patients). CONCLUSION: This severe central inflammation after LASIK could be an extreme manifestation of diffuse lamellar keratitis.- - - - - - - - - - ranking = 0.14285714285714keywords = keratitis (Clic here for more details about this article) |
4/9. Cluster of mycobacterium chelonae keratitis cases following laser in-situ keratomileusis.PURPOSE: To describe a cluster of mycobacterium chelonae keratitis cases involving patients who underwent laser in-situ keratomileusis (LASIK) at a single refractive surgery center. DESIGN: Descriptive case series of four patients and cohort study to identify disease associations. methods: Examination schedules, diagnostic tests, and therapy were based on best medical judgment. Isolates from three patients were compared by pulsed-field gel electrophoresis. epidemiologic studies were performed to identify the source of infection. RESULTS: Seven of eight eyes developed M. chelonae keratitis following bilateral simultaneous LASIK. Each patient was thought to have diffuse lamellar keratitis initially, but all seven eyes were noted to have opacities suggestive of infectious keratitis by 13 to 21 days after surgery. All eyes had undergone hyperopic LASIK over four days in April 2001 by one surgeon in a community-based refractive surgery center. A cohort study of all patients undergoing LASIK at the same center in April 2001 revealed that M. chelonae keratitis occurred only in persons undergoing correction of hyperopia (seven of 14 eyes vs. none of 217 eyes undergoing myopic LASIK, P <.001). The only difference identified between procedures was use of masks created from a soft contact lens in hyperopic LASIK. Three isolates (three patients) were indistinguishable by pulsed-field gel electrophoresis. Eyes were treated with a combination of antimicrobial agents, including topical azithromycin in three patients, with resolution of infection in all eyes over 6 to 14 weeks. The source of infection was not identified on environmental cultures. CONCLUSION: Postoperative nontuberculous mycobacterial keratitis can occur in an epidemic fashion following LASIK. Topical amikacin, azithromycin, clarithromycin, ciprofloxacin, or a combination of these agents, appears to be effective treatment for these infections.- - - - - - - - - - ranking = 1.4285714285714keywords = keratitis (Clic here for more details about this article) |
5/9. Epithelial defect, diffuse lamellar keratitis, and epithelial ingrowth following post-LASIK epithelial toxicity.This case reports an association between 2 uncommon flap complications in 1 eye related to epithelial toxicity and subsequent epithelial defect secondary to prolonged intraoperative exposure to topical anesthesia. A patient had hyperopic laser in situ keratomileusis (LASIK) for the correction of 2.75 1.75 x 70 in the left eye. Because of the patient's anxiety and movement, additional topical local anesthesia was used and the flap remained reflected for 5 minutes. Immediately postsurgery, a toxic appearance was noted in the epithelium of the LASIK flap; 24 hours later, a large central epithelial defect was identified. Three days post- LASIK, the epithelial defect had healed but diffuse lamellar keratitis was noted in the interface, particularly underlying the location of the original epithelial defect. Over 6 weeks, a self-limiting epithelial ingrowth developed in the inferior interface. Fourteen months post-LASIK, the uncorrected visual acuity was 6/9 with a residual refraction of 0.50 0.50 x 90.- - - - - - - - - - ranking = 0.71428571428571keywords = keratitis (Clic here for more details about this article) |
6/9. Confocal microscopy of stage 4 diffuse lamellar keratitis with spontaneous resolution.PURPOSE: To report confocal microscopic findings at the onset of stage 4 diffuse lamellar keratitis and after its resolution. Stage 4 is the most severe form of diffuse lamellar keratitis. Its incidence is approximately 1 in 5000 and is associated with stromal melting, deep flap folds, central haze, hyperopic shift, irregular astigmatism, and severe decrease in visual acuity. methods: A 22-year-old woman underwent bilateral uncomplicated laser in situ keratomileusis (LASIK) for myopia. Postoperative course in the right eye was uneventful; however, in the left eye, stage 4 diffuse lamellar keratitis developed. Confocal microscopy examination was performed in both eyes at the onset of the syndrome and after its resolution. Findings in the eye with diffuse lamellar keratitis (left eye) were compared with the uninvolved (right) eye. RESULTS: The condition improved spontaneously and 2 years later, slit-lamp microscopy showed resolution of the folds and haze with subsequent improvement of visual acuity. However, confocal microscopic examination in the left eye revealed a persistent stromal subclinical haze on both sides of the lamellar cut and prominent folds that extended into the anterior stroma. CONCLUSION: Confocal microscopy revealed that in spite of normal appearance on slit-lamp microscopy, micromorphological alterations persisted after spontaneous resolution of stage 4 diffuse lamellar keratitis.- - - - - - - - - - ranking = 1.2857142857143keywords = keratitis (Clic here for more details about this article) |
7/9. Infectious keratitis after photorefractive keratectomy in the united states army and navy.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.- - - - - - - - - - ranking = 1.4285714285714keywords = keratitis (Clic here for more details about this article) |
8/9. Hyeropic shift after LASIK induced diffuse lamellar keratitis.BACKGROUND: Diffuse lamellar keratitis (DLK) is a relatively new syndrome that is increasingly being reported after LASIK. We have observed that a hyperopic shift may be associated with the occurrence of this diffuse lamellar keratitis. CASE PRESENTATION: A 26 year old man developed bilateral diffuse lamellar keratitis (DLK) following myopic LASIK. The residual refractive error was 0.5D OD and 0.25D OS at the end of the first week. The sterile infiltrates resolved over a period of 4-6 weeks on topical steroid therapy. A progressive hyperopic shift was noted in the right eye with an error 4.25Dsph/ 0.25Dcyl 20 at the final follow up 6 months post surgery. CONCLUSION: Diffuse lamellar keratitis after LASIK may be associated with a significant hyperopic shift.- - - - - - - - - - ranking = 1.1428571428571keywords = keratitis (Clic here for more details about this article) |
9/9. Interface keratitis-induced stromal thinning: an early postoperative complication of laser in situ keratomileusis.Two patients had bilateral laser in situ keratomileusis on the same day at the same center. Both developed severe interface inflammation in the second of the 2 eyes treated, which led to stromal thinning corneal haze, and resultant hyperopia. These symptoms partially resolved over 7 weeks of follow-up.- - - - - - - - - - ranking = 0.57142857142857keywords = keratitis (Clic here for more details about this article) |