Infectious keratitis following photorefractive keratectomy: a 13-year study at a tertiary center
Abstract Introduction 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...
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SpringerOpen
2025-01-01
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| Series: | Journal of Ophthalmic Inflammation and Infection |
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| Online Access: | https://doi.org/10.1186/s12348-025-00452-2 |
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| author | Alireza Attar Hossein Jamali Julio Ortega-Usobiaga Golnoush Mahmoudinezhad Dagny Zhu Mohammad Mohammadi |
| author_facet | Alireza Attar Hossein Jamali Julio Ortega-Usobiaga Golnoush Mahmoudinezhad Dagny Zhu Mohammad Mohammadi |
| author_sort | Alireza Attar |
| collection | DOAJ |
| description | Abstract Introduction 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% (7/38,938). The odds of keratitis during the COVID-19 pandemic were 7.05 times higher (95% CI: 1.58 to 31.52, p-value = 0.015) than outside this timeframe (February 2020 to August 2023). Gram-positive bacteria were the most commonly isolated pathogens in microbiological studies, accounting for 45.2% (19/42) of cases. Early-onset infections were primarily caused by Staphylococcus aureus (9/26, 34.6%), Staphylococcus epidermidis (4/26, 15.4%), and Pseudomonas aeruginosa (4/26, 15.4%), whereas all of the cases with fungi (4/4, 100% (and Acanthamoeba (3/3, 100%) infections 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% (41/42) 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. |
| format | Article |
| id | doaj-art-902843436fed4950b316b4e665a7e939 |
| institution | Kabale University |
| issn | 1869-5760 |
| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-902843436fed4950b316b4e665a7e9392025-01-12T12:35:22ZengSpringerOpenJournal of Ophthalmic Inflammation and Infection1869-57602025-01-0115111010.1186/s12348-025-00452-2Infectious keratitis following photorefractive keratectomy: a 13-year study at a tertiary centerAlireza Attar0Hossein Jamali1Julio Ortega-Usobiaga2Golnoush Mahmoudinezhad3Dagny Zhu4Mohammad Mohammadi5Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical SciencesPoostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical SciencesDepartment of Cataract & Refractive Surgery, Clínica Baviera-AIER Eye Hospital GroupHamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San DiegoNVISION Eye CentersSchool of medicine, Shahid Sadoughi University of Medical sciencesAbstract Introduction 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% (7/38,938). The odds of keratitis during the COVID-19 pandemic were 7.05 times higher (95% CI: 1.58 to 31.52, p-value = 0.015) than outside this timeframe (February 2020 to August 2023). Gram-positive bacteria were the most commonly isolated pathogens in microbiological studies, accounting for 45.2% (19/42) of cases. Early-onset infections were primarily caused by Staphylococcus aureus (9/26, 34.6%), Staphylococcus epidermidis (4/26, 15.4%), and Pseudomonas aeruginosa (4/26, 15.4%), whereas all of the cases with fungi (4/4, 100% (and Acanthamoeba (3/3, 100%) infections 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% (41/42) 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.https://doi.org/10.1186/s12348-025-00452-2Infectious keratitisRefractive surgeryPhotorefractive KeratectomyPRKRisk factorsVisual acuity |
| spellingShingle | Alireza Attar Hossein Jamali Julio Ortega-Usobiaga Golnoush Mahmoudinezhad Dagny Zhu Mohammad Mohammadi Infectious keratitis following photorefractive keratectomy: a 13-year study at a tertiary center Journal of Ophthalmic Inflammation and Infection Infectious keratitis Refractive surgery Photorefractive Keratectomy PRK Risk factors Visual acuity |
| title | Infectious keratitis following photorefractive keratectomy: a 13-year study at a tertiary center |
| title_full | Infectious keratitis following photorefractive keratectomy: a 13-year study at a tertiary center |
| title_fullStr | Infectious keratitis following photorefractive keratectomy: a 13-year study at a tertiary center |
| title_full_unstemmed | Infectious keratitis following photorefractive keratectomy: a 13-year study at a tertiary center |
| title_short | Infectious keratitis following photorefractive keratectomy: a 13-year study at a tertiary center |
| title_sort | infectious keratitis following photorefractive keratectomy a 13 year study at a tertiary center |
| topic | Infectious keratitis Refractive surgery Photorefractive Keratectomy PRK Risk factors Visual acuity |
| url | https://doi.org/10.1186/s12348-025-00452-2 |
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