Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India.
Indian J Ophthalmol. 2020 Dec;68(12):3064-3066. doi: 10.4103/ijo.IJO_2418_19.
A 42-year-old female presented with pain, photophobia, and superficial corneal infiltrates in mid-periphery in the left eye, after 2 days of uneventful bilateral SMILE procedure. Inspite of the medical treatment with fortified antibiotics, the infection spread to the interface, close to visual axis reducing UDVA from 20/16 to 20/80. Immediate surgical intervention in the form of scraping of interface lesions with 26G needle, interface wash with antibiotics and photoactivated chromophore for keratitis (PACK-CXL) was performed. After 24 h of bacterial culture Staphylococcus aureus was yielded. Interface wash and PACK-CXL was repeated after 48 h by which infiltrates reduced and early scarring was observed by 10 post-op day. Subsequent topical steroids helped in limiting scar formation and UDVA improved to 20/30 at the final visit. Combined approach of interface wash with antibiotics and PACK-CXL may be a safe and effective modality in treating early onset infectious keratitis following SMILE surgery.
一位 42 岁女性在双眼 SMILE 手术后 2 天出现左眼中部周边疼痛、畏光和浅层角膜浸润。尽管使用强化抗生素进行了治疗,但感染仍扩散至角膜界面,接近视轴,导致最佳矫正视力(UDVA)从 20/16 下降至 20/80。立即进行了手术干预,用 26G 针头刮除界面病变,并用抗生素和光激活角膜染色质(PACK-CXL)冲洗界面。24 小时后细菌培养出金黄色葡萄球菌。48 小时后再次进行界面冲洗和 PACK-CXL,浸润减轻,并在术后 10 天观察到早期瘢痕形成。随后局部应用皮质类固醇有助于限制瘢痕形成,最终随访时 UDVA 提高至 20/30。联合应用抗生素冲洗和 PACK-CXL 可能是治疗 SMILE 手术后早期发生感染性角膜炎的一种安全有效的方法。