Infectious keratitis following photorefractive keratectomy: A 13-year study at a tertiary center.
Alireza Attar1 *
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract: Infectious keratitis is a rare but devastating complication following photorefractive keratectomy (PRK) that may lead to visual impairment. This study assessed the clinical features, treatment strategies, and outcomes of post-PRK infectious keratitis
Methods: This retrospective study was conducted on patients with post-PRK infectious keratitis presenting to Khalili Hospital, Shiraz, Iran, from June 2011 to March 2024. The study was conducted in two stages: the first stage assessed the incidence of post-PRK infectious keratitis among patients who underwent PRK at our center, while the second stage included all patients with post-PRK infectious keratitis, regardless of where their PRK was performed. The following data were collected: demographics, post-surgery presentation time, risk factors, culture results, treatments, follow-up duration, complications, and corrected distance visual acuity (CDVA) at admission and the last follow-up.
Results: Forty-two patients (42 eyes) with a mean age of 28.74 years (male-to-female ratio of 1.2:1) were included. Among 38,938 PRK procedures performed at our center, the incidence of keratitis was estimated to be 0.018%. The odds of keratitis during the COVID-19 pandemic were 7.05 times higher than outside this timeframe. Gram-positive bacteria were the most commonly isolated pathogens in microbiological studies. Early-onset infections were primarily caused by Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa, whereas fungi and Acanthamoeba more frequently caused late-onset infections. All patients received broad-spectrum antibiotic therapy, followed by adjusted treatment based on microbial results. Cases developing endophthalmitis and those not responding to treatment or having non-resolving corneal scars required further interventions, such as penetrating keratoplasty and deep vitrectomy. The mean follow-up duration was 40.81 months, and 97.6% of cases experienced CDVA improvement at follow-up.
Conclusion: This long-term study found a post-PRK keratitis rate of 0.018%, with gram-positive bacteria as the most common pathogens. Prompt management and regular follow-up assessments are essential for achieving satisfactory outcomes.
