Keratitis after implantation of intrastromal corneal ring segments

Abstract

A 53-year-old man had implantation of 2 intrastromal corneal ring segments (Intacs, Addition Technology Inc.) in the left eye. Several days after the lower segment was exchanged, an infiltrate was present at the corneal incision site. This progressed to a lower channel infection followed by diffuse keratitis. Culture from the conjunctiva was positive for Staphylococcus epidermidis, but cultures from the cornea were negative for microorganisms. Later, 2 gas bubbles appeared at the interface. The patient was treated with topical and subconjunctival antibiotics and channel irrigation. The keratitis resolved, leaving a neovascularized opacity at the nasal part of the lower channel.

Effectiveness of Antimicrobial Peptide Immobilization for Preventing Perioperative Cornea Implant-Associated Bacterial Infection

“…This was possibly due to the biodegradation or dysfunction of SESB2V peptide in the corneal stroma. Our results are encouraging for the early postoperative period, but bacterial endophthalmitis may occur months or years after the placement of a device (4)(5)(6). Hence, future work should examine the role of AMPs combined with a controlled drug delivery system, e.g., nanoparticles or biodegradable films.…”

“…Devices that penetrate the skin or those that are within tissues, e.g., the cornea, present the highest risks for infection (2,3). Endophthalmitis, a severe panocular infection, remains one of the most devastating complications after the implantation of any artificial corneal device, e.g., intracorneal stromal rings to correct refractive errors (4,5), Boston keratoprosthesis (6)(7)(8), and osteo-odonto keratoprosthesis (OOKP) (9, 10) used to restore vision in patients with end-stage corneal blindness. Patients with endophthalmitis present with discharge, lid swelling, pain, reduced vision acuity, implant erosion, or exposure (11).…”

Bilateral Infectious Keratitis After Implantation of Intrastromal Corneal Ring Segments

“…Although no specific intraoperative complication has been associated with the development of infectious keratitis, some of the possible risk factors include diabetes, trauma, and use of contact lens after implantation of ICRS. 5 No such risk factor was found in our patient.…”

“…5 Although any pathogen can cause this sight-threatening complication, microorganisms identified in some of the cases of early infectious keratitis include Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus viridans, Streptococcus pneumoniae, Clostridium perfringens, Pseudomonas species, Nocardia species, Klebsiella species, and Paecilomyces species. [5][6][7] Several mechanisms have been proposed to explain the development of infectious keratitis after implantation of Intacs. Some of these include inadequate preoperative cleaning of eyelids and eyelashes and shallow implantation of ICRS.…”

“…3,4 Infectious keratitis is an uncommon complication of the ICRS implantation. [5][6][7][8] Most published reports have been of unilateral keratitis and, to the best of our knowledge, no cases of simultaneous bilateral infectious keratitis have been reported. We report a case of bilateral infectious keratitis in a young woman after uncomplicated implantation of Intacs.…”