Keratitis following laser refractive surgery: Clinical spectrum, prevention and management

Das, Shilpa; Garg, Prashant; Mullick, Ritika; Annavajjhala, Sriram

doi:10.4103/ijo.ijo_2479_20

Cited by 14 publications

(14 citation statements)

References 37 publications

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“…The author himself followed the example of a study in which a similar response was observed in patients with sterile peripheral keratitis who suffered from blepharitis [24]. Today, this hypothesis is still valid, and many authors use it not only post-CXL but also after refractive procedures [23,25]. Recent reports suggest a strong relationship between vernal keratoconjunctivitis and Down's syndrome being risk factors for the development of sterile corneal infiltrates [8].…”

Section: Discussionmentioning

confidence: 92%

Retrospective Analysis of Sterile Corneal Infiltrates in Patients with Keratoconus after Cross-Linking Procedure

Krok

Wróblewska‐Czajka

Kokot

et al. 2022

JCM

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Background: This paper’s objective is to analyze patients with keratoconus who developed sterile infiltrate after corneal collagen cross-linking (CXL), and to evaluate possible risk factors for their occurrence. Methods: 543 medical histories of patients after cross-linking (Epi-off, Epi-on) procedure performed according to the Dresden protocol were analyzed retrospectively. Results: Sterile corneal infiltrates occurred in four men (0.7%) in the age range (16–28) years, the average age being 20.3. The average time from procedure to onset of symptoms was 3.5 days (2–5 days). Inflammatory infiltration resolved in all patients, leaving scars on corneal stroma in two patients. Corneal healing time ranged from 4–12 weeks. In vivo confocal microscopy (IVCM), round inflammatory cells, and Langerhans cells in the epithelium and Bowman’s layer were observed at the site of infiltration. The Optical coherence tomography (OCT) shows hyperreflective lesions of various sizes which decreased over time. The corneal topographic parameters and Best-corrected visual acuity (BCVA) improved after the CXL procedure in all of the described cases. Conclusions: Most likely, damage to the epithelium and the phototoxic effect of the procedure is of significant importance in the formation of sterile corneal infiltrates. Appropriate classification and selection of CXL procedures in combination with protective measures in people at risk may have an overwhelming impact on the incidence of this complication.

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Section: Discussionmentioning

confidence: 92%

Retrospective Analysis of Sterile Corneal Infiltrates in Patients with Keratoconus after Cross-Linking Procedure

Krok

Wróblewska‐Czajka

Kokot

et al. 2022

JCM

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“…Another conclusion is that in the third and fourth stages of DLK, at least one year delay is required to perform any secondary and corrective surgery, and the results of the intervention earlier than this time are uncertain due to continuous refractive changes and lack of stabilization 18,19 .…”

Section: Discussionmentioning

confidence: 99%

Evaluate the Prevalence, Natural Course, and Final Visual Acuity in Patients with Stages III or IV of Diffuse Lamellar Keratitis Following Laser in Situ Keratomileusis

Afshin Mansourian,

Bahman Sharifi

2021

Indian Journal of Forensic Medicine & Toxicology

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Background: And aim: The prevalence of DLK has been reported differently in different centers based on its severity. Hence, the aim of present study was evaluate the prevalence, natural course, and final visual acuity in patients with stages III or IV of diffuse lamellar keratitis following laser in situ keratomileusis. Methods:In the present descriptive study, 3941 eyes files from 2125 patients underwent LASIK surgery; were examined. All patients had a complete ophthalmologic examination before LASIK and had suitable conditions for LASIK.Result: Among the studied cases, 39 eyes (0.98%), out of 16 patients (0.75). The mean time interval between LASIK and DLK diagnosis was 3± 2.4 days. A history of allergy was negative in all patients. The mean post-operative spherical refractive error in all eyes was in the range of 1 diopters and the average cylindrical refractive error in 33 eyes was -0.66±1.2 diopters. The mean of final spherical refraction in 34 eyes was 0.5±1.2 diopter and the mean of final cylindrical refraction in 35 eyes was -0.75±1.3 diopter. Severe turbidity at the flap surface in the first week decreased over time in all patients with stage III and IV DLK. So that only in four eyes (10.25%) Conclusion:The prevalence of stages III and IV in DLK is negligible compared to the large number of LASIK procedures and all patients respond well to topical and systemic corticosteroid therapy.

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“…Herpetic keratitis too can present following laser refractive procedure as a primary infection or due to reactivation. [ 82 83 ] In flap procedures, the infiltrate usually occurs in the interface or is limited only to the lamellar flap, flap margin, or stroma. [ 83 84 ] For microbiological assessment in procedures with an interface, the flap needs to be lifted.…”

Section: Coexisting Ocular Diseasesmentioning

confidence: 99%

“…[ 82 83 ] In flap procedures, the infiltrate usually occurs in the interface or is limited only to the lamellar flap, flap margin, or stroma. [ 83 84 ] For microbiological assessment in procedures with an interface, the flap needs to be lifted. The undersurface of the flap or the interface is scraped, followed by a thorough wash with fortified antibiotics.…”

Section: Coexisting Ocular Diseasesmentioning

confidence: 99%

Update on diagnosis and management of refractory corneal infections

Agarwal

Khan

Vanathi

et al. 2022

Indian Journal of Ophthalmology

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Infectious keratitis is a medical emergency resulting in significant visual morbidity. Indiscriminate use of antimicrobials leading to the emergence of resistant or refractory microorganisms has further worsened the prognosis. Coexisting ocular surface diseases, delay in diagnosis due to inadequate microbiological sample, a slow-growing/virulent organism, or systemic immunosuppressive state all contribute to the refractory response of the ulcer. With improved understanding of these varied ocular and systemic factors contributing to the refractory nature of the microbes, role of biofilm formation and recent research on improving the bioavailability of drugs along with the development of alternative therapies have helped provide the required multidimensional approach to effectively diagnose and manage cases of refractory corneal ulcers and prevent corneal perforations or further dissemination of disease. In this review, we explore the current literature and future directions of the diagnosis and treatment of refractory keratitis.

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Keratitis following laser refractive surgery: Clinical spectrum, prevention and management

Cited by 14 publications

References 37 publications

Retrospective Analysis of Sterile Corneal Infiltrates in Patients with Keratoconus after Cross-Linking Procedure

Retrospective Analysis of Sterile Corneal Infiltrates in Patients with Keratoconus after Cross-Linking Procedure

Evaluate the Prevalence, Natural Course, and Final Visual Acuity in Patients with Stages III or IV of Diffuse Lamellar Keratitis Following Laser in Situ Keratomileusis

Update on diagnosis and management of refractory corneal infections

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