A case of suture-related bacterial keratitis and its treatment with topical imipenem

Abstract

Risk factors for the development of corneal infection include loose or broken sutures, corticosteroid use, persistent epithelial defects, contact lens use, keratoconjunctivitis sicca, and a history of herpes simplex virus keratitis. Most of the data regarding suture-related keratitis come from literature on penetrating keratoplasty [1]. However, suture-related keratitis following cataract surgery appears to be a rare event [2]. The treatment of bacterial keratitis in patients with or without sutures is similar. In the treatment of serious suture-related corneal infections, topical fortified antibiotic combinations like vancomycin (50 mg/mL) and gentamicin (14 mg/mL) [3] or ceftazidime (50 mg/mL) and vancomycin (50 mg/mL) [3] have been used successfully. However, despite intensive topical, subconjunctival, and systemic antibiotics, corneal perforation can develop [2]. Therefore, selection of the appropriate agent and treatment planning are important for treatment of corneal infections. A beta-lactam antibiotic, imipenem, has often been used systemically and as an intravitreal therapy. However, no study has reported the topical use of imipenem as a monotherapy in the treatment of bacterial keratitis in patients with or without corneal sutures. This report presents the treatment of corneal infection with topical imipenem (50 mg/mL) as monotherapy in a patient who developed an infectious corneal complication due to a broken corneal suture after extracapsular cataract extraction with posterior chamber intraocular lens implantation.