The Clinica Baviera, Instituto Oftalmológico Europeo, Spain.
Ophthalmology. 2010 Feb;117(2):232-8.e1-4. doi: 10.1016/j.ophtha.2009.07.011. Epub 2009 Dec 14.
To investigate the incidence, culture results, risk factors, and visual outcomes of infectious keratitis after LASIK, and examine treatment strategies.
Retrospective study.
We included 107 613 patients who underwent LASIK at Clínica Baviera (Instituto Oftalmológico Europeo, Spain) from September 2002 to May 2008.
The medical records of post-LASIK patients (204 586 eyes) were reviewed to identify cases of infectious keratitis. Incidence, risk factors, clinical course, days to diagnosis, medical and surgical treatment, and final visual outcomes were recorded.
Incidence of post-LASIK infectious keratitis, culture results, response to treatment, and visual outcome.
Post-LASIK infectious keratitis was diagnosed in 72 eyes from 63 patients. Onset of infection was early (within 7 days after surgery) in 62.5% of cases. Cultures were positive in 21 of 54 cases in which samples were taken. The most frequently isolated microorganism was Staphylococcus epidermidis (9 cases). Immediate flap lifting and irrigation with antibiotics was performed in 54 eyes; late flap lifting was subsequently required in 10 out of 18 cases initially treated with topical antibiotics alone. One case required flap amputation owing to flap necrosis. Final best spectacle-corrected visual acuity (BSCVA) was >or=20/20 in 38 cases (52.7%) and >or=20/40 in 67 cases (93.05%); final BSCVA was <20/40 in 5 cases (6.94%).
The incidence of post-LASIK infectious keratitis was 0.035% per procedure. Infectious keratitis after LASIK is a potentially vision-threatening complication. The appearance of infections in asymptomatic patients highlights the need for a proper schedule of follow-up appointments. Prompt and aggressive management of this LASIK complication with early flap lifting, scraping, culture, and irrigation with antibiotics is strongly recommended. Proper management can result in preserving useful vision.
FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.
调查 LASIK 术后感染性角膜炎的发生率、培养结果、危险因素和视力结果，并探讨治疗策略。
回顾性研究。
我们纳入了 2002 年 9 月至 2008 年 5 月在西班牙欧洲眼科研究所的 Baviera 诊所接受 LASIK 的 107613 例患者（204586 只眼）。
回顾性分析 LASIK 术后患者（204586 只眼）的病历，以确定感染性角膜炎的病例。记录发病率、危险因素、临床病程、诊断时间、药物和手术治疗以及最终视力结果。
LASIK 术后感染性角膜炎的发生率、培养结果、治疗反应和视力结果。
63 例患者的 72 只眼诊断为 LASIK 术后感染性角膜炎。62.5%的病例感染发生在术后 7 天内。54 例中有 21 例培养阳性。最常分离的微生物是表皮葡萄球菌（9 例）。立即行角膜瓣掀起术并进行抗生素冲洗，单独局部使用抗生素治疗的 18 例中有 10 例随后需要行晚期角膜瓣掀起术。1 例因角膜瓣坏死而需要行角膜瓣切除术。38 例（52.7%）最终最佳矫正视力（BSCVA）≥20/20，67 例（93.05%）最终 BSCVA≥20/40；5 例（6.94%）最终 BSCVA<20/40。
LASIK 术后感染性角膜炎的发生率为每例 0.035%。LASIK 术后感染性角膜炎是一种潜在的致盲性并发症。无症状患者出现感染提示需要适当的随访时间表。强烈建议通过早期角膜瓣掀起术、刮除术、培养和抗生素冲洗来及时、积极地治疗这种 LASIK 并发症。适当的处理可以保留有用的视力。
作者没有与本文讨论的任何材料有专有的或商业的利益。
