Microbial Keratitis Rare After LASIK or PRK Surgery

CHICAGO — Refractive surgery is a safe means of correcting refractive error.

Published studies report an infection rate of 0.02% to 1.50%, and a survey conducted by the American Society of Cataract and Refractive Surgery places the incidence of microbial keratitis at 0.034% in 2001 and 0.091% in 2008.

However, the incidence of microbial keratitis was only 0.0041% after procedures performed at a military refractive surgery center, according to research presented here at the American Academy of Ophthalmology 2012 Annual Meeting.

Vasudha A. Panday, MD, who practices at Lackland Air Force Base in Texas, and colleagues reviewed all 24,446 cases of photorefractive keratectomy (PRK) and LASIK surgery that took place from January 2005 to December 2011. They conducted a chart review and identified only 1 case of microbial keratitis.

That patient underwent PRK on August 25, 2009. One week after surgery, she reported a focal area of haze and staining in the right eye. She was restarted on antibiotics and topical steroids. Five weeks after surgery, she had a dendritic lesion, persistent infiltrate, and herpes simplex virus keratitis. She was prescribed acyclovir. At 2 months, the patient was found to be infected with Gram-positive bacteria and had a secondary fungal infection.

The infections were resolved by January 2010. In November 2010, the patient visited the clinic and was assessed for best corrected visual acuity. She was unhappy with her eye and underwent a second surgery, which was successful. Dr. Panday explained that "she was just monitored a bit more closely and kept on site for the next couple of weeks."

The low incidence of microbial keratitis at this military center is likely related to the patient population and regimented protocols. Most patients are on active duty, young, healthy, and receive 5 to 7 days of convalescent leave. Moreover, they require their commanders' authorization to undergo surgery. If the patient fails to follow-up with the physician, they open themselves up to punitive action.

Rajesh K. Rajpal, MD, from the See Clearly Vision group in Arlington, Virginia, sat on the panel that moderated the session. He complimented Dr. Panday, stating that she had presented a "very nice paper with obviously a large number of patients."

Dr. Panday has disclosed no relevant financial relationships. Dr. Rajpal reports consulting for multiple companies.

American Academy of Ophthalmology (AAO) 2012 Annual Meeting: Abstract PA019. Presented November 11, 2012.