alexa Infectious and noninfectious keratitis after laser in situ keratomileusis Occurrence, management, and visual outcomes.


Optometry: Open Access

Author(s): Moshirfar M, Welling JD, Feiz V, Holz H, Clinch TE, Moshirfar M, Welling JD, Feiz V, Holz H, Clinch TE

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Abstract PURPOSE: To retrospectively review the occurrence, treatment, and visual outcomes associated with various etiologies of keratitis as a postoperative complication of laser in situ keratomileusis (LASIK) at an academic surgical center. SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: The charts of 5618 post-LASIK patients (10 477 eyes) were reviewed for the development of keratitis. Occurrence rates, management regimens, and final best spectacle-corrected visual acuity (BSCVA) were reported for infectious and noninfectious keratitis etiologies. RESULTS: Post-LASIK keratitis was diagnosed in 279 eyes. The keratitis was diagnosed as infectious in 33 eyes (12\%) and as noninfectious in 246 eyes (88\%). Infectious cases included 5 eyes (15\%) with herpes simplex keratitis (HSV), 18 (55\%) with adenoviral keratitis, and 10 (30\%) with nonviral (including bacterial, fungal, and parasitic) keratitis. Of noninfectious cases, 193 (78\%) were classified as diffuse lamellar keratitis (DLK), 36 (15\%) as staphylococcal marginal hypersensitivity, and 17 (15\%) as localized debris-related keratitis. CONCLUSIONS: The occurrence of post-LASIK keratitis was 2.66\%, with DLK being the most common diagnosis overall. The occurrence of noninfectious keratitis (2.34\%) was 7.5 times greater than the occurrence of infectious keratitis (0.31\%). Adenoviral keratitis had the best visual outcomes overall, with all 18 patients achieving 20/20 BSCVA. In contrast, all 5 eyes with HSV keratitis lost 1 or 2 lines of BSCVA. Excluding adenoviral keratitis, infectious etiologies had significantly worse visual outcomes than noninfectious etiologies at the 20/40 and 20/20 levels (P = .0013 and P<.001, respectively). This article was published in J Cataract Refract Surg and referenced in Optometry: Open Access

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