Posters

Epidemic outbreak of severe mixed infectious keratitis following small-incision lenticule extraction at a refractive centre in Kuwait

Poster Details

First Author: H.Alrabiah KUWAIT

Co Author(s):    N. Alsaleem   F. Aljassar   A. Almassry   M. Alagouz   G. Alhamdan   J. Alió     

Abstract Details

Purpose:

To our knowledge we are showing for the first time an epidemic outbreak of mixed infectious keratitis after Small Incision Lenticule Extraction (SMILE) at one refractive surgery laser center in Kuwait.

Setting:

Albahar Eye Center, ministry of health, Alsabah Area, Kuwait. Vissum Innovation Alicante, Division of Ophthalmology, Miguel Hernandez University.

Methods:

This is a case series report, Clinical data of 4 female patients were reviewed. Age ranging from 18-37. They developed a mixed infectious keratitis after SMILE The data was obtained from the Albahar Eye Center where the cases were treated. The clinical presentation and subsequent management are presented. The management of infectious keratitis after SMILE is challenging because of the difficulties to perform scraping as well as the penetration of medication for deep infiltrates is restricted.

Results:

Four patients developed mixed infectious keratitis after SMILE. Time interval between SMILE and onset of infection was between1-8 weeks. Visual acuity(Snellen) at initial presentation ranged from 20/150 to counting-fingers. Biomicroscopy revealed infiltrates on corneal cap-stromal bed interface, epithelial defects, descement membrane folds and anterior chamber reaction. Atypical Mycobacterium, Nocardia and fungus were isolated. They received fortified vancomycin(50/ml), ceftazdime(50/ml), amikacin(500/2ml), and fluconazole. Keratoplasty was performed in 3eyes of 4patients. Final visual acuity was 20/50 in 3cases of post DALK and 1case 20/200 did not underwent a corneal surgery.

Conclusions:

To our knowledge, we are describing the first mixed infectious keratitis epidemic outbreak of post-SMILE surgery. Atypical microorganisms were the responsible cause of these cases, but the source of the etiology remain unknown. High degree of clinical suspicion for atypical microorganisms should be considered, even with early onset presentation. Surgical intervention such as PKP and DALK were necessary to treat such cases.

Financial Disclosure:

None