Moorfields Eye Hospital, 162 City Rd, London EC1V 2PD, UK.
Future Microbiol. 2011 Jul;6(7):819-31. doi: 10.2217/fmb.11.61.
Corneal laser refractive surgery is increasingly being performed on patients with the aim of improving unaided vision. Most candidates for surgery have excellent spectacle- or contact lens-corrected vision. Although microbial keratitis following refractive surgery is a rare complication, and usually has a good visual outcome, it can be sight-threatening. The spectrum of pathogens differs to other causes of microbial keratitis, such as contact lens-associated keratitis, and a different management approach is required. Postoperatively, patients are prescribed topical steroids and broad-spectrum topical antibiotics, typically fluoroquinolones. These do not cover unusual organisms, such as fungi, Nocardia, Acanthamoeba and some atypical mycobacteria. In post-laser-assisted in situ keratomileusis microbial keratitis, the lamellar flap should be lifted to acquire samples for specific microbiological examination, including these atypical organisms. Confocal microscopy is a noninvasive test that provides morphological information, and is operator dependent, but may assist in the rapid diagnosis of fungal, Acanthamoeba or Norcardia keratitis. PCR is not in widespread use, but has high sensitivity and specificity, and may facilitate early diagnosis and specific treatment of the causative organism, which is critical in obtaining the best clinical outcome.
角膜激光屈光手术越来越多地应用于提高裸眼视力的患者。大多数手术候选者都有极好的矫正眼镜或隐形眼镜视力。虽然屈光手术后的微生物角膜炎是一种罕见的并发症，通常有良好的视觉预后，但它可能会威胁视力。病原体谱与其他微生物角膜炎（如接触镜相关性角膜炎）不同，因此需要不同的治疗方法。术后，患者被开具局部类固醇和广谱局部抗生素，通常是氟喹诺酮类药物。这些药物不能覆盖真菌、诺卡菌、棘阿米巴原虫和某些非典型分枝杆菌等不常见的病原体。在激光辅助原位角膜磨镶术后微生物角膜炎中，应掀起层状瓣以获取特定微生物检查的样本，包括这些非典型病原体。共焦显微镜是一种非侵入性测试，可以提供形态学信息，但其结果依赖于操作者，但可能有助于快速诊断真菌、棘阿米巴或诺卡菌角膜炎。聚合酶链反应（PCR）尚未广泛应用，但具有很高的灵敏度和特异性，可能有助于早期诊断和针对病原体的特异性治疗，这对于获得最佳临床结果至关重要。
