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Researchers report 13 cases of MRSA keratitis after laser refractive surgery
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Researchers identified 13 cases of infection by methicillin-resistant Staphylococcus aureus in eyes treated with laser refractive surgery procedures, possibly representing the first reported series of infectious keratitis caused by the organism, according to the study authors.
"According to a computerized MEDLINE literature search, this is the first case series of MRSA (methicillin-resistant Staphylococcus aureus) infectious keratitis following refractive surgery, the first reports of MRSA keratitis after refractive surgery in patients with no known exposure to a health care facility, the first report of MRSA keratitis after [LASIK] enhancement, and the first reports of MRSA keratitis after prophylaxis with fourth-generation fluoroquinolones," the study authors said.
Eric D. Donnenfeld, MD, and colleagues reviewed records for 13 cases of MRSA keratitis at 10 centers. The study included eight patients treated with primary LASIK, one patient treated with a LASIK enhancement and two patients treated with PRK. One of the PRK patients developed a bilateral infection, according to the study.
Five patients were health care workers, and four had exposure to health care settings. Three patients denied having any exposure to health care settings, the authors noted.
In all cases, the infection was located at the interface and was associated with interface inflammation. Physicians treated all cases with two topical antibiotics, including fortified vancomycin in all but one case. This one patient received fortified gentamicin and cefazolin, according to the study.
In addition, surgeons performed penetrating keratoplasty in two patients. Another four eyes are awaiting PK and one eye is awaiting phototherapeutic keratectomy (PTK).
"After treatment, in the eyes not scheduled for a PK or PTK, best corrected visual acuity ranged from 20/20 to 20/100," the authors reported.
"MRSA infectious keratitis is a potentially serious complication following refractive surgery," the authors wrote.
"Surgeons should now be vigilant for community-acquired MRSA keratitis. All patients should be informed of the risk factors and warning signs of infectious keratitis and need to be advised to seek medical attention immediately if they develop signs or symptoms of infectious keratitis. A high degree of suspicion, coupled with prompt and appropriate treatment, may result in improved visual recovery," they said.
The study is published in the April issue of American Journal of Ophthalmology.