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Methicillin-resistant Staphylococcus aureus infectious keratitis following refractive surgery.
Am J Ophthalmol. 2007 Apr; 143(4):629-34.AJ

Abstract

PURPOSE

To elucidate risk factors, clinical course, visual outcomes, and treatment of culture-proven methicillin-resistant Staphylococcus aureus (MRSA) infectious keratitis following refractive surgery.

DESIGN

Interventional case series.

METHODS

Multicenter chart review of 13 cases of MRSA keratitis following refractive surgery and literature review.

RESULTS

Thirteen eyes of 12 patients, nine of whom were either healthcare workers or exposed to a hospital surgical setting, developed MRSA keratitis following refractive surgery. All patients presented with a decrease in visual acuity and complaints of pain or irritation in the affected eye. Common signs on slit-lamp biomicroscopy were corneal epithelial defects, focal infiltrates with surrounding edema, conjunctival injection, purulent discharge, and hypopyon. All patients were diagnosed with infectious keratitis on presentation and treated with two antibiotics. All eyes were culture-positive for MRSA.

CONCLUSIONS

According to a computerized MEDLINE literature search, this is the first case series of MRSA infectious keratitis following refractive surgery, the first reports of MRSA keratitis after refractive surgery in patients with no known exposure to a healthcare facility, the first report of MRSA keratitis after a laser in situ keratomileusis (LASIK) enhancement, and the first reports of MRSA keratitis after prophylaxis with fourth-generation fluoroquinolones. MRSA keratitis is a serious and increasing complication following refractive surgery. Patients with exposure to a healthcare environment should be considered at additional risk for developing MRSA keratitis. However, in addition, surgeons should now be vigilant for community-acquired MRSA. Prompt identification with culturing and appropriate treatment of MRSA keratitis after refractive surgery is important to improve visual rehabilitation.

Authors+Show Affiliations

Ophthalmic Consultants of Long Island, Rockville Centre, New York 11570, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Multicenter Study

Language

eng

PubMed ID

17320811

Citation

Solomon, Renée, et al. "Methicillin-resistant Staphylococcus Aureus Infectious Keratitis Following Refractive Surgery." American Journal of Ophthalmology, vol. 143, no. 4, 2007, pp. 629-34.
Solomon R, Donnenfeld ED, Perry HD, et al. Methicillin-resistant Staphylococcus aureus infectious keratitis following refractive surgery. Am J Ophthalmol. 2007;143(4):629-34.
Solomon, R., Donnenfeld, E. D., Perry, H. D., Rubinfeld, R. S., Ehrenhaus, M., Wittpenn, J. R., Solomon, K. D., Manche, E. E., Moshirfar, M., Matzkin, D. C., Mozayeni, R. M., & Maloney, R. K. (2007). Methicillin-resistant Staphylococcus aureus infectious keratitis following refractive surgery. American Journal of Ophthalmology, 143(4), 629-34.
Solomon R, et al. Methicillin-resistant Staphylococcus Aureus Infectious Keratitis Following Refractive Surgery. Am J Ophthalmol. 2007;143(4):629-34. PubMed PMID: 17320811.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Methicillin-resistant Staphylococcus aureus infectious keratitis following refractive surgery. AU - Solomon,Renée, AU - Donnenfeld,Eric D, AU - Perry,Henry D, AU - Rubinfeld,Roy S, AU - Ehrenhaus,Michael, AU - Wittpenn,John R,Jr AU - Solomon,Kerry D, AU - Manche,Edward E, AU - Moshirfar,Majid, AU - Matzkin,Dennis C, AU - Mozayeni,Reza M, AU - Maloney,Robert K, Y1 - 2007/02/23/ PY - 2005/08/01/received PY - 2006/12/13/revised PY - 2006/12/17/accepted PY - 2007/2/27/pubmed PY - 2007/4/20/medline PY - 2007/2/27/entrez SP - 629 EP - 34 JF - American journal of ophthalmology JO - Am J Ophthalmol VL - 143 IS - 4 N2 - PURPOSE: To elucidate risk factors, clinical course, visual outcomes, and treatment of culture-proven methicillin-resistant Staphylococcus aureus (MRSA) infectious keratitis following refractive surgery. DESIGN: Interventional case series. METHODS: Multicenter chart review of 13 cases of MRSA keratitis following refractive surgery and literature review. RESULTS: Thirteen eyes of 12 patients, nine of whom were either healthcare workers or exposed to a hospital surgical setting, developed MRSA keratitis following refractive surgery. All patients presented with a decrease in visual acuity and complaints of pain or irritation in the affected eye. Common signs on slit-lamp biomicroscopy were corneal epithelial defects, focal infiltrates with surrounding edema, conjunctival injection, purulent discharge, and hypopyon. All patients were diagnosed with infectious keratitis on presentation and treated with two antibiotics. All eyes were culture-positive for MRSA. CONCLUSIONS: According to a computerized MEDLINE literature search, this is the first case series of MRSA infectious keratitis following refractive surgery, the first reports of MRSA keratitis after refractive surgery in patients with no known exposure to a healthcare facility, the first report of MRSA keratitis after a laser in situ keratomileusis (LASIK) enhancement, and the first reports of MRSA keratitis after prophylaxis with fourth-generation fluoroquinolones. MRSA keratitis is a serious and increasing complication following refractive surgery. Patients with exposure to a healthcare environment should be considered at additional risk for developing MRSA keratitis. However, in addition, surgeons should now be vigilant for community-acquired MRSA. Prompt identification with culturing and appropriate treatment of MRSA keratitis after refractive surgery is important to improve visual rehabilitation. SN - 0002-9394 UR - https://www.unboundmedicine.com/medline/citation/17320811/Methicillin_resistant_Staphylococcus_aureus_infectious_keratitis_following_refractive_surgery_ DB - PRIME DP - Unbound Medicine ER -