EYE INFECTIONS AFTER REFRACTIVE KERATOTOMY

BACKGROUND: Ocular infections are serious and potentially vision-threa tening complications of refractive keratotomy. We have performed an in tegrative review of published literature to address important issues c oncerning these complications. METHODS: Articles in MEDLINE and publis hed manuscripts and abstracts reporting previously unpublished cases o f infections after refractive keratotomy were systematically identifie d and reviewed. Our review did not target patients treated with relaxi ng incisions for postkeratoplasty astigmatism Pertinent data were abst racted and analyzed. RESULTS: Forty-three cases (47 episodes: 42 kerat itis and 5 endophthalmitis) of infection appeared in 26 published repo rts from 1975 to 1994. The frequency ranged from 0.25% to 0.70%. In 22 (47%) eyes, infection occurred before 2 weeks. Thirty-five (74%) infe ctions were located in the inferior half of the cornea, and 22 (62%) w ere located in the inferotemporal quadrant. Thirty-one (66%) infection s were bacterial (32% gram-positive, 23% gram-negative, 9% acid fast, 496 unknown), 5% fungal, 6% viral, 19% sterile, and 4% of unknown orig in. Spectacle-corrected visual acuity after conservative treatment was 20/40 or better in 70% of eyes, Penetrating keratoplasty was performe d in six cases. Potential associations included reoperations in 12 (26 %) eyes, postoperative contact lens wear in 7 (15%), and intraoperativ e perforation in 7 (15%). CONCLUSIONS: The published literature indica tes that infections after refractive keratotomy may compromise visual function. Approximately half of the infections occur in the first 2 we eks. Reoperations, postoperative contact lens wear, and intraoperative perforations may be significant risk factors.