Keratitis after Implantation of Intrastromal Corneal Ring Segments (Intacs) Aided by Femtosecond Laser for Keratoconus Correction: Case Report and Description of the Literature

Abstract

The majority of reported cases of infectious keratitis after intrastromal corneal ring segment implantation have been described after mechanical implantation of the segments. We present a case of keratitis after implantation of intrastromal corneal ring segments (Intacs) aided by femtosecond laser for keratoconus correction and review the relevant literature. A 31-year-old woman with keratoconus underwent uneventful sequential implantation of intrastromal corneal ring segments (Intacs) aided by femtosecond laser performed 6 weeks apart. Two months after surgery in the second eye, she complained of red eye, pain, and decreased vision of 2 days' duration. Left eye visual acuity was 20/100. Slit-lamp examination of the left eye revealed a stromal infiltrate at the lower segment near the incision site. The infiltrate progressed despite topical treatment of vancomycin and ceftazidime. Cultures were negative. The inferior segment was removed and the inferior channel irrigated with antibiotics. One day later significant fibrin and 1-mm hypopyon were detected in the anterior chamber Significant improvement was observed after adding topical amikacin and amphotericin B. Six months later, a small stromal scar is present at the inferior incision site and best-corrected visual acuity is 20/25. To our knowledge, this is the second reported case of keratitis after implantation of intrastromal corneal ring segments (Intacs) aided by femtosecond laser for keratoconus correction. Prompt and adequate treatment is essential to prevent irreversible reduction of visual acuity.