Jonathan B. Rubenstein

Infectious keratitis after laser in situ keratomileusis: Results of an ASCRS survey

&NA; To investigate the incidence, culture results, treatment, and visual outcomes of infectious keratitis after laser in situ keratomileusis (LASIK) worldwide, the Cornea Clinical Committee of the American Society of Cataract and Refractive Surgery (ASCRS) contacted 8600 United States and international ASCRS members by e‐mail and asked them to respond to a questionnaire about post‐LASIK infectious keratitis. One hundred sixteen infections were reported by 56 LASIK surgeons who had performed an estimated 338 550 procedures. Seventy‐six cases presented in the first week after surgery, 7 during the second week, 17 between the second and fourth weeks, and 16 after 1 month. Forty‐seven cases were not diagnosed on initial presentation. The most common organisms cultured were atypical mycobacteria and staphylococci. Empiric therapy is not recommended as most of the organisms are opportunistic and not responsive to conventional therapy. Flap elevation and culturing should be performed when post‐LASIK infectious keratitis is suspected.

Acanthamoeba-Contaminated Hydrogel Contact Lenses

Acanthamoeba keratitis has frequently been associated with contact lens use. In this study, contaminated hydrogel contact lenses of patients were subjected to disinfection by thermal hydrogen peroxide and chemical (quaternary ammonium) systems. New hydrogel contact lenses contaminated by incubation on Acanthamoeba polyphaga plates were similarly subjected to the disinfection systems described above. Thermal disinfection was universally effective in eradicating acanthamoeba, whereas hydrogen peroxide and quaternary ammonium disinfection were ineffective. Scanning electron microscope photomicrographs suggest that acanthamoeba may adhere to surfaces of hydrogel contact lenses. These findings have significant implications for soft contact lens users.

Correction of hyperopia following radial keratotomy: quantification in human cadaver eyes.

Overcorrection is a significant complication following radial keratotomy (RK). This study using human cadaver eyes demonstrates that the use of interrupted sutures placed across radial incisions coincident with a 7-mm optical zone mark can induce a wide range of central corneal steepening and can therefore correct varying amounts of hyperopia following RK. A case presentation confirms the effectiveness of using interrupted sutures to steepen the cornea following RK, but it also shows that significant regression of the effect must be considered at the time of suture placement. Since placement of interrupted corneal sutures is a routine procedure, it is a very convenient technique for treating overcorrection following RK.

Unsuspected infectious keratitis in host corneal buttons

Infectious keratitis may be unsuspected preoperatively in patients undergoing penetrating keratoplasty. We have diagnosed five cases of previously unknown corneal infection discovered only after post-keratoplasty histopathologic examination using specific stains. These cases of preoperatively unsuspected infectious keratitis illustrate examples where histopathologic examination using specialized stains may alert the physician to the need for appropriate postoperative antimicrobial therapy. Furthermore, these cases illustrate the ability of soft contact lenses to mask symptoms of infectious keratitis. Additionally, the clinical appearance of advanced bullous keratopathy may mask signs of infectious keratitis.