Bacterial keratitis after photorefractive keratectomy and laser in situ keratomileusis (LASIK) is well known.1–3 We encountered 2 cases of acute hemorrhagic keratoconjunctivitis following LASIK during an ongoing epidemic caused by Enterovirus 70.
Bilateral simultaneous LASIK surgery was performed in both patients in December 1998. Postoperative treatment included betamethasone 0.1%–neomycin and polymyxin B sulfates and gramicidin 0.5% (Neosporin®) eyedrops 4 times a day. Slitlamp examinations 1 and 24 hours postoperatively were unremarkable. On the second postoperative day, the patients developed pain, watering, photophobia, chemosis, and patchy subconjunctival hemorrhages in both eyes. However, the corneal flap was intact and the cornea was clear, with no evidence of keratitis. A diagnosis of acute hemorrhagic conjunctivitis was made. The corticosteroid–antibiotic combination was withdrawn, and the patients were started on framycetin drops 4 times daily, cold compresses, artificial tears, and decongestant drops; they were asked to wear dark glasses. Within a week, they developed superficial keratitis with punctate opacities involving the epithelium, subepithelium, and anterior stroma. The keratoconjunctivitis resolved after 2 to 3 weeks, and the patients had uncorrected visual acuities of 20/20 in both eyes.
Acute hemorrhagic keratoconjunctivitis occurs as a result of person-to-person contamination. The incubation period of Enterovirus 70 is 48 hours. It is possible that the surgery in these patients was performed in apparently normal eyes during the incubation period. However, the possibility that the infection was acquired in the postoperative period cannot be ruled out.
Corneal involvement deeper than anticipated occurred in these cases, possibly from surgical trauma induced by LASIK, which leads to broken epithelial barriers, compromising the ocular surface and exposing the stromal bed to the presence of infectious organisms in the conjunctiva.
Coincidentally, both patients had contact examinations 1 day prior to LASIK and instrument-borne infection cannot be ruled out. A greater caution is therefore warranted when performing preoperative contact examinations such as specular microscopy, ultrasonicpachymetry, and biometry in patients who are to have LASIK.
Namrata Sharma MD
Tanuj Dada MD
Vijay K Dada MBBS, MS
Rasik B Vajpayee MBBS, MS
aNew Delhi, India
References
1. Pérez-Santonja JJ, Sakla HF, Abad JL, et al. Nocardial keratitis after laser in situ keratomileusis. J Refract Surg 1997; 13:314-317
2. Reviglio V, Rodriguez ML, Picotti GS, et al. Mycobacterium chelonae keratitis following laser in situ keratomileusis. J Refract Surg 1998; 14:357-360
3. Watanabe H, Sato S, Maeda N, et al. Bilateral corneal infection as a complication of laser in situ keratomileusis. Arch Ophthalmol 1997; 115:1593-1594
