Fasciani Romina, Agresta Antonio, Caristia Alice, Mosca Luigi, Scupola Andrea, Caporossi Aldo
Department of Head and Neck Surgery, Ophthalmology Unit, Catholic University of the Sacred Heart "A. Gemelli", Largo "A. Gemelli" 8, 00168 Rome, Italy.
Case Rep Ophthalmol Med. 2015;2015:613273. doi: 10.1155/2015/613273. Epub 2015 Mar 18.
Purpose. To report the risk of methicillin-resistant Staphylococcus aureus (MRSA) ocular infection after UVA-riboflavin corneal collagen cross-linking in a patient with atopic dermatitis. Methods. A 22-year-old man, with bilateral evolutive keratoconus and atopic dermatitis, underwent UVA-riboflavin corneal cross-linking and presented with rapidly progressive corneal abscesses and cyclitis in the treated eye five days after surgery. The patient was admitted to the hospital and treated with broad-spectrum antimicrobic therapy. Results. The patient had positive cultures for MRSA, exhibiting a strong resistance to antibiotics. Antibiotic therapy was modified and targeted accordingly. The intravitreal reaction is extinguished, but severe damage of ocular structures was unavoidable. Conclusion. Riboflavin/UVA corneal cross-linking is considered a safe procedure and is extremely effective in halting keratoconus' progression. However, this procedure is not devoid of infectious complications, due to known risk factors and/or poor patients' hygiene compliance in the postoperative period. Atopic dermatitis is a common disease among patients with keratoconus and Staphylococcus aureus colonization is commonly found in patients with atopic dermatitis. Therefore, comorbidity with atopic dermatitis should be thoroughly assessed through clinical history before surgery. A clinical evaluation within three days after surgery and the imposition of strict personal hygiene rules are strongly recommended.
目的。报告一名特应性皮炎患者在接受紫外线A-核黄素角膜胶原交联术后发生耐甲氧西林金黄色葡萄球菌（MRSA）眼部感染的风险。方法。一名22岁男性，患有双侧进行性圆锥角膜和特应性皮炎，接受了紫外线A-核黄素角膜交联术，术后五天，术眼出现快速进展的角膜脓肿和睫状体炎。患者入院并接受了广谱抗菌治疗。结果。患者MRSA培养呈阳性，对多种抗生素耐药。相应地调整了抗生素治疗方案。玻璃体内反应消退，但眼部结构的严重损伤已无法避免。结论。核黄素/紫外线A角膜交联术被认为是一种安全的手术，在阻止圆锥角膜进展方面极其有效。然而，由于已知的风险因素和/或患者术后卫生依从性差，该手术并非没有感染并发症。特应性皮炎在圆锥角膜患者中是一种常见疾病，而金黄色葡萄球菌定植在特应性皮炎患者中也很常见。因此，术前应通过临床病史全面评估特应性皮炎合并症。强烈建议术后三天内进行临床评估并严格执行个人卫生规则。
