Methicillin-Resistant Staphylococcus aureus Infectious Keratitis Following Refractive Surgery

Solomon, Renée; Donnenfeld, Eric D.; Perry, Henry D.; Rubinfeld, Roy S.; Ehrenhaus, Michael; Wittpenn, John R.; Solomon, Kerry D.; Manche, Edward E.; Moshirfar, Majid; Matzkin, Dennis C.; Mozayeni, Reza M.; Maloney, Robert K.

doi:10.1016/j.ajo.2006.12.029

« Previous Next »American Journal of Ophthalmology
Volume 143, Issue 4 , Pages 629-634, April 2007

Methicillin-Resistant Staphylococcus aureus Infectious Keratitis Following Refractive Surgery

Renée Solomon
- Ophthalmic Consultants of Long Island, Rockville Centre, New York
Eric D. Donnenfeld
- Ophthalmic Consultants of Long Island, Rockville Centre, New York
- Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, New York
- 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
Henry D. Perry
- Ophthalmic Consultants of Long Island, Rockville Centre, New York
Roy S. Rubinfeld
- Washington Eye Physicians and Surgeons, Chevy Chase, Maryland; and Georgetown University Medical Center, and the Washington Hospital Center, Washington, DC
Michael Ehrenhaus
- Saint Vincent Catholic Medical Center of Brooklyn and Queens, St Joseph’s Hospital, Flushing, New York
John R. Wittpenn Jr
- Ophthalmic Consultants of Long Island, Rockville Centre, New York
- Department of Ophthalmology, State University of New York at Stony Brook, Stony Brook, New York
Kerry D. Solomon
- Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
Edward E. Manche
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California
Majid Moshirfar
- Moran Eye Center, University of Utah, Salt Lake City, Utah
Dennis C. Matzkin
- EyeSight Laser Center, Atlanta, Georgia
Reza M. Mozayeni
- Providence Eye and Laser Specialists, Charlotte, North Carolina
Robert K. Maloney
- Maloney Vision Institute, Los Angeles, California.

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.