Methicillin-Resistant Staphylococcus aureus Infectious Keratitis Following Refractive Surgery
Accepted 17 December 2006. published online 25 January 2007.
Purpose
To elucidate risk factors, clinical course, visual outcomes, and treatment of culture-proven methicillin-resistant Staphylococcus aureus (MRSA) infectious keratitis following refractive surgery.
Design
Interventional case series.
Methods
Multicenter chart review of 13 cases of MRSA keratitis following refractive surgery and literature review.
Results
Thirteen eyes of 12 patients, nine of whom were either healthcare workers or exposed to a hospital surgical setting, developed MRSA keratitis following refractive surgery. All patients presented with a decrease in visual acuity and complaints of pain or irritation in the affected eye. Common signs on slit-lamp biomicroscopy were corneal epithelial defects, focal infiltrates with surrounding edema, conjunctival injection, purulent discharge, and hypopyon. All patients were diagnosed with infectious keratitis on presentation and treated with two antibiotics. All eyes were culture-positive for MRSA.
Conclusions
According to a computerized MEDLINE literature search, this is the first case series of MRSA infectious keratitis following refractive surgery, the first reports of MRSA keratitis after refractive surgery in patients with no known exposure to a healthcare facility, the first report of MRSA keratitis after a laser in situ keratomileusis (LASIK) enhancement, and the first reports of MRSA keratitis after prophylaxis with fourth-generation fluoroquinolones. MRSA keratitis is a serious and increasing complication following refractive surgery. Patients with exposure to a healthcare environment should be considered at additional risk for developing MRSA keratitis. However, in addition, surgeons should now be vigilant for community-acquired MRSA. Prompt identification with culturing and appropriate treatment of MRSA keratitis after refractive surgery is important to improve visual rehabilitation.
aOphthalmic Consultants of Long Island, Rockville Centre, New York
bDepartment of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, New York
cWashington Eye Physicians and Surgeons, Chevy Chase, Maryland; and Georgetown University Medical Center, and the Washington Hospital Center, Washington, DC
dSaint Vincent Catholic Medical Center of Brooklyn and Queens, St Joseph’s Hospital, Flushing, New York
eDepartment of Ophthalmology, State University of New York at Stony Brook, Stony Brook, New York
fStorm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
gDepartment of Ophthalmology, Stanford University School of Medicine, Stanford, California
hMoran Eye Center, University of Utah, Salt Lake City, Utah
jProvidence Eye and Laser Specialists, Charlotte, North Carolina
kMaloney Vision Institute, Los Angeles, California.
Inquiries to Eric D. Donnenfeld, Ophthalmic Consultants of Long Island, Ryan Medical Arts Building, Suite 402, 2000 North Village Avenue, Rockville Centre, New York 11570
ABSTRACT