Keratitis after Implantation of Intrastromal Corneal Rings with Spontaneous Extrusion of the Segment

Abstract

Purpose: To report a case of bacterial keratitis in a patient with a history of intrastromal corneal ring segments (INTACS®) implantation to correct keratoconus. Methods: The patient’s history, clinical presentation, pathological analysis and therapeutic management were reviewed. Results: A 36-year-old-man was referred to our department due to decreased vision and intense pain in his left eye, 40 days after INTACS® implantation for keratoconus. Slit-lamp examination revealed epithelial defects and stromal infiltrates in the lower channel without evidence of the inferior ring. The anterior chamber also showed a significant fibrin reaction to hypopyon. A low-tension suture was removed at the site of the incision. Microbiological study of the conjunctival swab was positive for Staphylococcus epidermidis, but the corneal culture was sterile. The patient was treated with topical fortified and systemic antibiotics. The infection slowly resolved, leaving opacity at the inferior segment site. Conclusions: Infectious keratitis following INTACS implantation is an infrequent complication that can have important consequences without suitable and early therapeutic management.

Microbial keratitis following intracorneal ring implantation

“…Shehadeh‐Masha'our et al reported a case of keratitis three days after implantation of Intacs, and mentioned the gap in the corneal incision and an infiltrate at the incision site. Hashemi et al and Ibanez‐Alperte et al reported cases of keratitis 40 days after Intacs insertion with loose sutures and wound gap. They suggested precise incision placement and wound closure to reduce the risk of keratitis.…”

Aspergillus fumigatus keratitis following intracorneal ring segment implantation

“…Microbial keratitis is a serious sight threatening condition. Although infection after ICRS implantation is uncommon, it has been described in more than one report [2-5]. The consequences of this infection could serious; Hofling-Lima et al described in his series two patients that required penetrating keratoplasty [3].…”

“…Microbial keratitis has been reported previously following this procedure [2-5]. Bacterial keratitis was the commonest entity; Staphylococcus and Streptococcus were the predominant organisms isolated [5,6]. Although aspergillus species were described before as a cause of keratitis [7], it was never reported –up to our knowledge- following ICRS implantation.…”

INTACS for Keratoconus and Ectasia After LASIK

“…Erosion of the INTACS occurs most commonly due to superficial placement, but can also occur as a result of infections dermatitis (58). If this occurs the INTACS should be removed, the dermatitis treated if present and the eye allowed healing.…”