Abstract

FR.22.01

Serious bilateral keratitis after Lasik – case report and literature survey

Stephan Linke, Christos Skevas, Gisbert Richard, Toam Katz

Universitäts-Augenklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg

Introduction
To report a case of severe bilateral infectious keratitis after bilateral laser in situ keratomileusis (LASIK), to review the literature and to explore preventive, diagnostic, and therapeutic measures.
Patients and methods
Interventional case report and literature review. A 31-year-old man was referred to us 2 months after bilateral LASIK with bilateral stromal infiltrates. Corneal scrapings from the edge of the infiltrate and underneath the flap were taken for microscopic examination and inoculation on culture media. Treatment consisted of irrigation of stromal bed with claforan and voriconazol along with half hourly instillation of erythromycin/colistin (Ecolicin, Chauvin Ankerpharm), levofloxacín (Oftaquix, Santen) and voriconazol (VFend, Pfizer) eye drops. In addition patient was given systemic ciproflocxacin (Cibrobay 2x500mg, AbZ Pharma).
Results
Cultures from the corneal scrapings of both eyes revealed growth of aspergillus fumigatus, koagulase negative staphylococcus and  achromobacter xylosoxidans. After initial response to flap lift, wash and intensive local and systemic therapy there was progressive thinning of corneal stroma in both eyes, and massive anterior chamber dense white infiltrates, that reappeared in spite of repeated anterior chamber irrigation. Penetrating keratoplasties had to be performed in both eyes. Achromobacter xylosoxidans was isolated from both corneal buttons and therapy was changed to 8x Chloramphenicol/Prednisolon eye drops (Aquapred, Dr Winzer Pharma) and intravenously Meropenem (Meronem 3x500mg, CC-Pharma) according to sensitivity testing. Two months after surgery both transplants stayed clear.
Discussion
The risk of bilateral infectious keratitis must be kept in mind when performing bilateral simultaneous LASIK. Although rare achromobacter xylosoxidans should be considered as an etiologic agent in such cases and might necessitate bilateral penetrating keratoplasty. Achromobacter`s resistance to antimicrobial therapy and prominent anterior chamber reaction might be attributed to the sectretion of an extracellular polymer matrix (biofilm).

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