Update on Infectious Keratitis after Refractive Surgery

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Presentation transcript:

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 The project is a collaboration between BPEI and RSMAS and the respective representatives. 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

Trichosporon spp infection 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

Mycobacteria (MOTT) infection 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 limiting the increased morbidity associated with delayed diagnosis and initiation of appropriate treatment in these types of infections. Mycobacteria (MOTT) infection post-LASIK

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

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)

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

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

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%

Results: Risk Factors 3 eyes – trauma (foreign body) 1 eye – enhancement 1 eye – previous Radial Keratotomy (RK) 7 eyes – none

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%)

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