Increased incidence of corneal perforation after topical fluoroquinolone treatment for microbial keratitis

PURPOSE: To compare the incidence of corneal perforation in eyes treated wi th topical fluoroquinolone or fortified antibiotics for microbial keratitis , METHODS: A retrospective medical record review of patients hospitalized for bacterial keratitis from January 1991 through November 1999, RESULTS: Two hundred seventy-seven cases of bacterial keratitis were identi fied. The incidence of corneal perforations was significantly higher in flu oroquinolonetreated eyes (18 out of 142, 12.7%) compared with eyes treated with fortified antibiotics (1 out of 135, 0.7%) (chi-square = 13.6, degrees of freedom (df) = 2, P <.001). Within the fluoroquinolone-treated group, a ll corneal perforations occurred in those eyes treated with ofloxacin (18 o ut of 125, 14.4%). Corneal perforations that occurred in the ofloxacin-trea ted eyes were not associated with any particular microbial isolate. CONCLUSION: Our data suggest an increased risk of corneal perforation after fluoroquinolone treatment for bacterial keratitis compared with treatment with fortified antibiotics. Further studies are warranted to verify this as sociation and establish possible mechanisms by which topical fluoroquinolon es may alter corneal collagen or keratocyte function. (Am J Ophthalmol 2001 ;131: 131-133, (C) 2001 by Elsevier Science Inc. All rights reserved.).