Infectious keratitis outbreak after laser in situ keratomileusis at a single laser center in Japan.

Author(s): Yamaguchi T, Bissen-Miyajima H, Hori-Komai Y, Matsumoto Y, Ebihara N, Takahashi H, Tsubota K, Shimazaki J

Affiliation(s): Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan.

Publication date & source: 2011-05, J Cataract Refract Surg., 37(5):894-900. Epub 2011 Mar 23.

Publication type: Multicenter Study

PURPOSE: To evaluate an outbreak of infectious keratitis after laser in situ keratomileusis (LASIK) at a single laser center in Japan. SETTING: Tokyo Dental College, Chiba, Japan. DESIGN: Case series. METHODS: Relevant demographic and clinical data were obtained from case records using a standardized multicenter questionnaire at 12 major hospitals. The clinical manifestations, management, and outcomes were analyzed. RESULTS: Thirty-nine eyes of 30 patients developed infectious keratitis after LASIK at the specified clinic. Cases of infection continued to appear over a 5-month period. The most common interval between LASIK and the onset of infection was within 2 weeks (36 eyes, 92.3%). Slitlamp manifestation included granular opacity beneath flap (71.8%), multiple infiltration (66.7%), and epithelial defect (30.8%). Mycobacterium was identified as the causative organism in 9 eyes (23.1%). In most cases, topical amikacin, arbekacin, and erythromycin in addition to fourth-generation fluoroquinolones were effective. Flap amputation was necessary in 10 eyes (25.6%) of 10 patients. Decimal visual acuity at initial presentation was worse than 0.10 in 14 eyes (35.9%), 0.15 to 0.50 in 8 eyes (20.5%), and 0.60 to 0.90 in 7 eyes (17.9%) and was better than 1.00 in 10 eyes (25.6%). Final decimal visual acuity was worse than 0.10 in 2 eyes (5.1%), 0.15 to 0.50 in 5 eyes (12.8%), and 0.60 to 0.90 in 11 eyes (28.2%) and was better than 1.00 in 21 eyes (53.8%). CONCLUSIONS: Mycobacterium was identified as the causative organism of this outbreak. This study shows the possibility of an epidemic of post-LASIK infectious keratitis. Copyright (c) 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.