Original Research Articles
Vol. 31 No. 1 (2024)
https://doi.org/10.4081/ltj.2024.389

Infectious keratitis after photorefractive keratectomy, femtosecond-LASIK and lenticule extraction in a 100,000-eye case series

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Received: 29 January 2024
Accepted: 14 February 2024
Published: 27 February 2024
1309
Views
368
Downloads
Photorefractive keratectomy (PRK), LASIK, lenticule extraction (KLEx), infection, keratitis

Authors

Antonio Leccisotti
leccisotti@libero.it
Siena Eye Laser, Poggibonsi, Siena, Italy; School of Biomedical Sciences, Ulster University, Coleraine, United Kingdom.
Stefania V. Fields
Siena Eye Laser, Poggibonsi, Siena, Italy.
Giuseppe De Bartolo
https://orcid.org/0000-0002-6666-2440
Siena Eye Laser, Poggibonsi, Siena, Italy.
Christian Crudale
https://orcid.org/0009-0006-4002-1481
Siena Eye Laser, Poggibonsi, Siena, Italy.

This study evaluates the incidence and outcome of infectious keratitis after laser vision correction by photorefractive keratectomy (PRK), femtosecond LASIK, and keratorefractive lenticule extraction (KLEx) in a retrospective, consecutive, single-institute series. Patients with presumed infectious keratitis between 2011 and 2023 were analyzed. In PRK, manual deepithelialization was done, and mitomycin C was used with spherical equivalents greater than 3 diopters. Femtosecond LASIK and KLEx were performed with an LDV Ziemer laser; the interface was rinsed in both techniques. All treatments received post-operative netilmicin eyedrops. Finally, 106269 eyes of 54278 patients were included; 6 eyes of 6 patients were identified as having infectious keratitis (3 by staphylococci, 3 culture-negative). The overall incidence of infectious keratitis was 0.0056% (0.0164% after PRK, 0.0023% after femtosecond LASIK, 0.1366% after KLEx; Chi2 p<0.00001). The odds ratio for PRK compared to LASIK was 7.2 (p=0.0307); for KLEx compared to LASIK 59.7 (p=0.0008). Presentation after KLEx (2 days) was earlier than after PRK (5, 4, and 5 days) and LASIK (6 and 4 days). In all cases, hourly fortified cefazolin and tobramycin eyedrops were used, with a good response: 3 eyes maintained a 20/20 uncorrected visual acuity; 2 eyes 20/20 with myopic astigmatism; 1 eye ended 20/25 with correction because of irregular astigmatism. In conclusion, infectious keratitis was a rare complication, more common after KLEx and less common after femtosecond-LASIK. Only 3/6 cases had a positive culture. All the cases in our series had a favorable outcome.

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Ang M, Gatinel D, Reinstein DZ, et al. Refractive surgery beyond 2020. Eye 2021;35:362–82. DOI: https://doi.org/10.1038/s41433-020-1096-5
Schallhorn JM, Schallhorn SC, Hettinger K, Hannan S. Infectious keratitis after laser vision correction: incidence and risk factors. J Cataract Refract Surg 2017;43:473–9. DOI: https://doi.org/10.1016/j.jcrs.2017.01.017
Afsharpaiman S, Zare M, Yasemi M, et al. The prevalence of infectious keratitis after keratorefractive surgery: A systematic review and meta-analysis study. J Ophthalmology, 2020;2020:6329321. DOI: https://doi.org/10.1155/2020/6329321
Sekundo W, Kunert KS, Blum M. Small incision corneal refractive surgery using the small incision lenticule extraction (SMILE) procedure for the correction of myopia and myopic astigmatism: results of a 6 month prospective study. Br J Ophthalmol 2011;95:335–9. DOI: https://doi.org/10.1136/bjo.2009.174284
Ivarsen A, Asp S, Hjortdal J. Safety and complications of more than 1500 small-incision lenticule extraction procedures. Ophthalmology 2014;121:822-8. DOI: https://doi.org/10.1016/j.ophtha.2013.11.006
Leccisotti A, Fields SV, De Bartolo G. Femtosecond-LASIK retreatments after primary myopic photorefractive keratectomy. Cornea 2023;42:675-9. DOI: https://doi.org/10.1097/ICO.0000000000003074
Leccisotti A, Fields SV, De Bartolo G. Refractive corneal lenticule extraction with the CLEAR femtosecond laser application. Cornea 2023;42:1247-56. DOI: https://doi.org/10.1097/ICO.0000000000003123
Wroblewski KJ, Pasternak JF, Bower KS, et al. Infectious keratitis after photorefractive keratectomy in the United States Army and Navy. Ophthalmology 2006;113:520–5. DOI: https://doi.org/10.1016/j.ophtha.2005.09.038
Leccisotti A, Bartolomei A, Greco G, Manetti C. Incidence of bacterial keratitis after photorefractive keratectomy. J Refract Surg 2005;21:96. DOI: https://doi.org/10.3928/1081-597X-20050101-20
de Rojas V, Llovet F, Martínez M, et al. Infectious keratitis in 18651 laser surface ablation procedures. J Cataract Refract Surg 2011;37:1822–31. DOI: https://doi.org/10.1016/j.jcrs.2011.04.037
Llovet F, de Rojas V, Interlandi E, et al. Infectious keratitis in 204,586 LASIK procedures. Ophthalmology 2010;117:232–8. DOI: https://doi.org/10.1016/j.ophtha.2009.07.011
Hondur A, Bilgihan K, Cirak MY, et al. Microbiologic study of soft contact lenses after laser subepithelial keratectomy for myopia. Eye Contact Lens 2008;34:24–7. DOI: https://doi.org/10.1097/ICL.0b013e31805881c2
Li J, Ren SW, Dai LJ, et al. Bacterial keratitis following small incision lenticule extraction. Infect Drug Resist 2022;15:4585–93. DOI: https://doi.org/10.2147/IDR.S367328
Ganesh S, Brar S, Nagesh BN. Management of infectious keratitis following uneventful small-incision lenticule extraction using a multimodal approach – A case report. Indian J Ophthalmol 2020;68:3064-6. DOI: https://doi.org/10.4103/ijo.IJO_2418_19
Chehaibou I, Sandali O, Ameline B, et al. Bilateral infectious keratitis after small-incision lenticule extraction. J Cataract Refract Surg 2016;42:626-30. DOI: https://doi.org/10.1016/j.jcrs.2016.03.024
Liu HY, Chu HS, Chen WL, et al. Bilateral non-tuberculous mycobacterial keratitis after small incision lenticule extraction. J Refract Surg 2018;34:633-6. DOI: https://doi.org/10.3928/1081597X-20180827-01
Chan TC, Chow VW, Jhanji V. Collagen cross-linking with photoactivated riboflavin (PACK-CXL) for bacterial keratitis after small incision lenticule extraction (SMILE). J Refract Surg 2017;33:278-80. DOI: https://doi.org/10.3928/1081597X-20170126-01
Garg P, Chaurasia S, Vaddavalli PK, et al. Microbial keratitis after LASIK. J Refractive Surg 2010;26:209–16. DOI: https://doi.org/10.3928/1081597X-20100224-07
Patel NR, Reidy JJ, Gonzalez-Fernandez F. Nocardia keratitis after laser in situ keratomileusis: clinicopathologic correlation, J Cataract Refractive Surg 2005;31:2012–5. DOI: https://doi.org/10.1016/j.jcrs.2005.02.049
Karp CL, Tuli SS, Yoo SH, et al. Infectious keratitis after LASIK. Ophthalmology 2003;110:503–10. DOI: https://doi.org/10.1016/S0161-6420(02)01760-8
Chang MA, Jain S, Azar DT. Infections following laser in situ keratomileusis: an integration of the published literature. Surv Ophthalmol 2004;49:269–80. DOI: https://doi.org/10.1016/j.survophthal.2004.02.007
Donnenfeld ED, O’Brien TP, Solomon R, et al. Infectious keratitis after photorefractive keratectomy. Ophthalmology 2003;110:743–7. DOI: https://doi.org/10.1016/S0161-6420(02)01936-X

Ethics Approval

The study has been granted an exemption from requiring ethics approval by the Institutional Review Board at Siena Eye Laser. Ethical approval is not required for this study by national guidelines. All patients provided written consent to participate.

CRediT authorship contribution

Antonio Leccisotti, Stefania V. Fields: conceptualization, writing – original draft; Giuseppe De Bartolo: data analysis, writing – review & editing; Christian Crudale: conceptualization, data analysis. All the authors read and approved the final version of the manuscript and agreed to be accountable for all aspects of the work.

Data Availability Statement

All data generated or analyzed during the study are included in this article.

How to Cite



Leccisotti, A., Fields, S. V., De Bartolo, G., & Crudale, C. (2024). Infectious keratitis after photorefractive keratectomy, femtosecond-LASIK and lenticule extraction in a 100,000-eye case series. Laser Therapy, 31(1). https://doi.org/10.4081/ltj.2024.389
Copyright (c) 2024 the Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.