Infectious Keratitis in 204 586 LASIK Procedures

Purpose: To investigate the incidence, culture results, risk factors, and visual outcomes of infectious keratitis after LASIK, and examine treatment strategies. Design: Retrospective study. Participants: We included 107 613 patients who underwent LASIK at Clinica Baviera (Instituto Oftalmologico Europeo, Spain) from September 2002 to May 2008. Methods: The medical records of post-LASIK patients (204 586 eyes) were reviewed to identify cases of infectious keratitis. Incidence, risk factors, clinical course, days to diagnosis, medical and surgical treatment, and final visual outcomes were recorded. Main Outcome Measures: Incidence of post-LASIK infectious keratitis, culture results, response to treatment, and visual outcome. Results: Post-LASIK infectious keratitis was diagnosed in 72 eyes from 63 patients. Onset of infection was early (within 7 days after surgery) in 62.5% of cases. Cultures were positive in 21 of 54 cases in which samples were taken. The most frequently isolated microorganism was Staphylococcus epidermidis (9 cases). Immediate flap lifting and irrigation with antibiotics was performed in 54 eyes; late flap lifting was subsequently required in 10 out of 18 cases initially treated with topical antibiotics alone. One case required flap amputation owing to flap necrosis. Final best spectacle-corrected visual acuity (BSCVA) was >= 20/20 in 38 cases (52.7%) and >= 20/40 in 67 cases (93.05%); final BSCVA was <20/40 in 5 cases (6.94%). Conclusions: The incidence of post-LASIK infectious keratitis was 0.035% per procedure. Infectious keratitis after LASIK is a potentially vision-threatening complication. The appearance of infections in asymptomatic patients highlights the need for a proper schedule of follow-up appointments. Prompt and aggressive management of this LASIK complication with early flap lifting, scraping, culture, and irrigation with antibiotics is strongly recommended. Proper management can result in preserving useful vision. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. Ophthalmology 2010; 117: 232-238 (C) 2010 by the American Academy of Ophthalmology.