INFECTIOUS CORNEAL ULCERATIONS AND ENDOPH THALMITIS AFTER PHOTOREFRACTIVE KERATECTOMY WITH USE OF DISPOSABLE CONTACT-LENS

Background Infections of the cornea with or without involvement of int raocular tissues are severe complications after photorefractive kerate ctomy. We report on three cases with ulcerative keratitis and one case with severe endophthalmitis, which developed some days after laser tr eatment. Patients and methods After 39 photo-therapeutic and 118 photo -refractive treatments without complications four young treated person s suffered from corneal infiltrations. Three of them developed severe corneal ulcerations, one a severe endophthalmitis. We used the laser m achine of the company Schwind (193 nm wavelenghth, repetition rate 10 Hz, fluence 180-200 mJ/cm(2)). One part of the treatment which all pat ients had in common was the application of a disposable contact lens p ostoperatively, which was worn overnight. Therapy and follow-up Becaus e all three patients with ulcerations revealed hyphen of fungi in thei r corneal-scratch material they were treated with antifungal agents lo cally and systemically. Due to the local and temporal connection the p atient with the endophthalmitis was treated with antifungal agents, to o. All corneal ulcerations healed with scars similar to a haze graded 3 to 4, the eye with the endophthalmitis healed almost completely. Con clusion Probably the use of disposable contactlenses postoperatively, especially the overnight wear, during an extremly hot and humid summer lead to the described severe infections of the eyes after the ''traum atisation'' of the cornea by the excimer laser. A known higher concent ration of Aspergillus in the air due to renovations of buildings in th e clinical area might have been an additional negative effect. The avo idance of the use of disposable contact lenses postoperatively, especi ally the overnight wear, is emphazised.