Atlas of Ophthalmology

Hemolytic Beta Streptococcus Keratitis after Laser Epithelial Keratomileusis (Clinical Course 12 Days, Colour Photography)

Cornea -> Surgical Procedures and Postoperative Findings -> Complications
Patient: 38 years of age, female, BCVA Light Perception at OD. Ocular Medical History: infection occurred on postoperative day 2 after laser epithelial keratomileusis (LASEK). Culture was positive for Streptococcus agalactiae (Hemolytic Beta Streptococcus). Treatment consisted of topical fortified tobramycin and fortified cephazolin. General Medical History: empty. Main Complaint: pain, vision loss. Purpose: to show microbiological keratits 2 days after LASEK. Methods: Colour photography anterior segment, over a period of 12 days. Findings: Colour photography, postoperative day 2 after LASEK (31.10.14): No ring infiltrate, diffuse superficial infiltration, no hypopyon. Colour photography, postoperative day 5 after LASEK (3.11.14): Stromal infiltration, focal deep infiltration. Colour photography, postoperative day 9 after LASEK (7.11.14): Stromal infiltration, focal deep infiltration, epithelial defect. Colour photography, postoperative day 12 after LASEK (10.11.14): Stromal infiltration, focal deep infiltration. Colour photography, postoperative day 16 after LASEK (14.11.14): superficial infiltration, small epithelial defect. Discussion: The risk of infectious keratitis after LASEK or PRK is relatively low, but potentially vision-threatening complication. Wroblewski et al. (1) showed in a retrospective chart review that of 25.337 PRK procedures clinically suspected infectious keratitis developed in 5 eyes of 5 patients (5/25337). Liu X et al (2) reported the bacterial contamination of bandage disposable soft contact lenses after laser subepithelial keratectomy (LASEK) and photorefractive keratectomy (PRK). He found in 30 eyes of 15 consecutive patients treated with LASEK and in 30 eyes of 15 consecutive patients who underwent PRK (PRK group) five positive cultures (17%) in LASEK group, and 2 positive cultures in the PRK group. No clinical finding of infection was noted. The culture of our patient was positive for Streptococcus agalactiae. The Lancefield Group B Streptococcus (GBS; Streptococcus agalactiae) has been considered principally to be a perinatal pathogen and a cause of puerperal infection in women. It was reported by Ormerod (3), that the superimposition of GBS infection on a damaged ocular surface is a serious event and can be a particularly virulent cause of keratitis in adults. Literature: (1) Wroblewski KJ, Pasternak JF, Bower KS, Schallhorn SC, Hubickey WJ, Harrison CE, Torres MF, Barnes SD.Infectious keratitis after photorefractive keratectomy in the United States army and navy. Ophthalmology.2006 Apr;113(4):520-5. Epub 2006 Feb 17. (2) Liu X, Wang P, Kao AA, Jiang Y, Li Y, Long Q. Bacterial contaminants of bandage contact lenses used after laser subepithelial or photorefractive keratectomy. Eye Contact Lens. 2012 Jul;38(4):227-30. (3) Ormerod LD, Paton BG. Severe group B streptococcal eye infections in adults. J Infect. 1989 Jan;18(1):29-34.

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