Acute hydrops with secondary bacterial keratitis: sequelae of paediatric refractive surgery

Abstract

A 24-year-old male patient with bilateral high myopia presented to our outpatient department with sudden onset of pain and diminution of vision in his right eye. He had sequentially undergone bilateral trabeculectomy and photorefractive keratectomy at the age of 6 years in both eyes. This was followed by radial keratotomy in right eye at the age of 8 years. The slit lamp examination demonstrated the presence of infiltrates in central cornea with an underlying fluid cleft, along with 14 radial keratotomy scars. Anterior segment optical coherence tomography confirmed the presence of intrastromal cleft in communication with anterior chamber. Bacterial culture revealed coagulase-negative Staphylococcus. The patient was successfully treated with fortified antibiotics in conjunction with the sensitivity report. This case underlines the need for a cautious approach towards refractive surgery in paediatric age group and highlights the long-term sequelae of retreatments in these cases.

Update on Paediatric Refractive Surgery

“…13 Recently, a case of an acute hydrops with secondary bacterial keratitis as a sequela of paediatric refractive surgery was reported in a young adult with a history of trabeculectomy and PRK and RK around 5-6 years of age. 45 An already accepted awareness as well as a profound concern exists among refractive surgeons over the long-term safety of such In a 3-year anterior chamber phakic IOL-implantation study, endothelial cell loss was at 7-15 % and myopic regression was at -1.0 D. 40 In a 5-year phakic IOL-implantation study, the CDVA had improved to 0.36±0.38LogMAR from 0.84±0.52 in patients with mean pre-operative SE refraction of -10.14±6.96 D and endothelial cell density was greater than 2,000 c/mm 2 in 80 % of patients. 42 In one of the first studies of foldable iris-fixated intraocular lens in children with bilateral and unilateral myopia, CDVA had improved from mean 0.84±0.4LogMAR…”