ASCRS White Paper : Management of infectious keratitis following laser in situ keratomileusis

Laser in situ keratomileusis (LASIK) is the most commonly performed refractive surgical procedure for the correction of ametropia. The advantages of LASIK include rapid visual rehabilitation, decreased stromal scarring, less irregular astigmatism, minimal regression, less postoperative pain, and the ability to treat a greater range of refractive disorders. Unlike surface-ablation procedures, LASIK preserves the integrity of Bowman’s membrane and the overlying epithelium, thus decreasing the risk for microbial keratitis. However, microbial keratitis following LASIK has become an increasingly recognized, sight-threatening complication of refractive surgery. The incidence of infectious keratitis following LASIK is difficult to estimate and can vary widely depending on the source of the information. One large retrospective study investigating the complications associated with LASIK found an incidence of 2 infections in 1062 eyes; a similar study found an incidence of 1 infection in 1019 eyes. A more recent case series of LASIK-associated infections encountered at a single institution reports an estimated incidence between 1:1000 and 1:5000. Based on a comprehensive review and analysis of the literature on infections following LASIK, Chang et al. state that the incidence of infection after LASIK can vary widely (0% to 1.5%). In a survey by the American Society of Cataract and Refractive Surgery (ASCRS), the incidence reported by LASIK surgeons who had experienced an infectious keratitis was 1 in 2919 cases performed during the year 2001. In this study of 116 cases, 76 presented the first week after surgery, 7 during the second week, 17 between the second week and the fourth week, and 16 after 1 month. The most common organisms cultured were atypical mycobacteria (33 of 116 cases, 28%) and staphylococci (23 of 116 cases, 20%) species. In 47 of the 116 cases, infectious keratitis was