IntroductionThe purpose of this study was to report the first case of acute bacterial keratitis produced by methicillin-resistant Staphylococcus aureus after the implantation of two intracorneal ring segments during an uneventful procedure for treating keratoconus in a 13-year-old child.Case ReportA patient with grade III keratoconus underwent an implantation of intracorneal ring segments with no complications during the procedure. Three days later, a whitish corneal infiltrate appeared in between the union of both corneal rings. Sample cultures were positive for methicillin-resistant S. aureus (MRSA). Corneal infiltrate did not improve despite intensive topical and systemic antibiotics. Melting appeared even after the explantation of both corneal rings. Keratoplasty à chaud had to be performed to preserve the eye integrity.ConclusionsMRSA keratitis following intracorneal ring segment implantation is a rare but severe complication that can lead to a therapeutic penetrating keratoplasty to definitely cure the process.
PURPOSE:
To analyze the clinical outcomes obtained with asymmetric intracorneal corneal ring segments (ICRS) of variable thickness and width in patients with keratoconus, identifying predictive parameters of the final visual outcome.
METHODS:
This prospective, longitudinal, non-comparative clinical trial enrolled 35 eyes of 27 patients with keratoconus with a significant difference among corneal topographic and comatic axes. All eyes underwent implantation of AJL-pro+ ICRS (AJL Ophthalmic). Visual, refractive, corneal topographic and aberrometric, and pachymetric changes were evaluated during a 3-month follow-up.
RESULTS:
Significant changes were detected at 3 months after surgery in manifest sphere and cylinder, spherical equivalent, overall blur strength, and corrected distance visual acuity (CDVA) (
P
< .001). No losses of two or more lines of CDVA were observed, whereas 94.3% (33) of eyes gained one or more lines of CDVA. Keratometric readings and the magnitude of anterior corneal astigmatism were significantly reduced with surgery (
P
< .001), as well as the levels of corneal coma (
P
< .001) and spherical aberration (
P
= .007). Likewise, a significant change toward less prolateness was observed (
P
< .001). Significant correlations were found among the change in CDVA and preoperative CDVA (
r
= −0.532,
P
= .001), and between the change in primary coma root mean square and the preoperative level of spherical aberration (
r
= −0.542,
P
= .001) and coma root mean square (
r
= −0.719,
P
< .001).
CONCLUSIONS:
The implantation of the ICRS evaluated in keratoconus with no coincidence between topographic and comatic axes regularizes the corneal shape and reduces the level of higher order aberrations, inducing a significant visual improvement.
[
J Refract Surg
. 2021;37(10):693–699.]
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