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Lift LASIK flap in cases of infectious keratitis
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BARCELONA — Elevating the flap and then culturing and scraping beneath it is how infectious keratitis after LASIK should be approached, according to a presentation sponsored by the American Society of Cataract and Refractive Surgery Cornea Clinical Committee.
“If there is ever a time when it is important to elevate the flap, it’s after LASIK. These patients have all been on prophylactic antibiotics, so the idea of treating empirically with an antibiotic that has already been ineffectual suggests that whatever is underneath that flap is not going to be sensitive to the current antibiotic that’s being used,” OSN Cornea/External Disease Board Member Eric D. Donnenfeld, MD, said at the International Conference on Ocular Infections held jointly with the European Society of Cataract and Refractive Surgeons meeting. Furthermore, consider irrigating antibiotic under the flap at the time of culture and scraping, Donnenfeld suggested.
Eric D. Donnenfeld
Comparing ASCRS membership survey results from 2002, 2005 and 2008, Donnenfeld said
infections are 2.5 times more common with PRK than when a keratome is used and six times more common with PRK than when femtosecond laser is used, “suggesting that the risk of infection with PRK is significantly higher than the risk with LASIK.”
The committee recommended that all cases of post-LASIK infectious keratitis be cultured and scrapings be performed using Gram stain, Gomori methenamine silver stain or Ziehl-Neelsen stain. In cases of acute onset, less than a week, the committee recommended a fourth-generation fluoroquinolone. – by Patricia Nale, ELS
Disclosure: Donnenfeld reports he is a consultant for AcuFocus, Allergan, Alcon, Abbott Medical Optics, AqueSys, Bausch + Lomb, Beaver-Visitec, Elenza, Glaukos, Icon Biosciences, Kala, Katena, LacriPen, Mati Pharmaceuticals, Merck, Mimetogen, NovaBay, Novaliq, OcuHub, Odyssey, Omeros, Pfizer, PRN, RPS, Shire, Strathspey Crown, TearLab, TearScience, TLC Laser Centers, TrueVision, Versant Ventures, WaveTec and Zeiss.