Infectious keratitis after photorefractive keratectomy in a comanaged setting

A 48-year-old man had simultaneous bilateral photorefractive keratectomy (P RK). The surgeon who performed the PRK did not see the patient in follow-up , and there was confusion regarding the comanaging doctor. Therefore, the p atient was not examined immediately postoperatively. Several days later, he was hospitalized for an unrelated, painful orthopedic problem and heavily sedated. Seven days after the PRK, an ophthalmologist was consulted for ocu lar irritation and discharge. Examination showed bilateral, purulent conjun ctivitis and severe infectious keratitis in the left eye. The patient was t reated with periocular and topical antibiotics. Corneal cultures yielded St aphylococcus aureus. The keratitis resolved slowly, leaving the patient wit h hand motion visual acuity. A corneal transplant and cataract extraction w as performed 15 months later, resulting in a best corrected visual acuity o f 20/400 because of glaucomatous optic nerve damage. Severe infectious kera titis may occur after PRK. Poor communication between the surgeon, comanagi ng doctor, and patient may result in treatment delay. J Cataract Refract Su rg 2000, 26;140-141 (C) 2000 ASCRS and ESCRS.