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Bilateral Infectious Keratitis After Implantation of Intrastromal Corneal Ring Segments

Chaudhry, Imtiaz A MD, PhD; Al-Ghamdi, Ali A MD; Kirat, Omar MD; Al-Swelmi, Farhan MD; Al-Rashed, Waleed MD; Shamsi, Farrukh A MPhil, PhD

doi: 10.1097/ICO.0b013e3181a87b35
Case Report

Purpose: To report the development of bilateral infectious keratitis after implantation of intrastromal corneal ring segments (ICRSs).

Design: Retrospective case report.

Participants: A 20-year-old woman presented with photophobia, decreased vision, and pain 11 days after uncomplicated implantation of ICRSs for keratoconus in both eyes. Bilateral corneal stromal infiltrates were noted at the site of ICRSs implantation.

Intervention: The patient was started on frequent topical fortified antibiotics in both eyes. Despite aggressive medical management, stromal infiltrates progressed, necessitating removal of ICRSs from both corneas to control infectious keratitis and melting of cornea.

Methods: Retrospective case report of a 20-year-old woman who developed bilateral severe infectious keratitis 11 days after uncomplicated implantation of ICRSs for keratoconus.

Results: Cultures obtained at the time of initial presentation yielded Streptococcus viridans. Patient responded well to the treatment and was left with stromal scars in both corneas.

Conclusions: Although rare, simultaneous implantation of ICRSs may carry a risk of severe bilateral infectious keratitis. Early recognition of infection, aggressive treatment with antibiotics, and, in some cases, removal of ICRSs may be necessary to prevent serious sight-threatening complication of this refractive procedure.

From the *Oculoplastic and Orbit Division; †Anterior Segment Division, Department of Ophthalmology; and ‡Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

Received for publication September 17, 2008; revision received March 11, 2009; accepted March 30, 2009.

Reprints: Imtiaz A. Chaudhry, MD, PhD, Oculoplastic and Orbit Division, King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh 11462, Saudi Arabia (e-mail:

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