Infectious Keratitis Following Femtosecond Laser-Assisted Astigmatic Keratotomy

Femtosecond laser-assisted astigmatic keratotomy (FSAK) is performed during femtosecond laser-assisted cataract surgery (FLACS) to address mild corneal astigmatism. Although considered efficient and relatively safe, complications may still occur. We present the features of four consecutive patients admitted with severe infectious keratitis following uneventful FSAK performed during FLACS.

An academic tertiary canter eye institute,

The medical records of all patients admitted with acute keratitis and a history of FSAK were reviewed, including their medical history, clinical examinations, surgical details, laboratory results, imaging, treatments, and outcomes.

We identified four consecutive cases in which all patients underwent uneventful FLACS with FSAK in the horizontal meridian. In three out of four cases, the FSAK was penetrating, while in one patient, it was intrastromal. The interval between surgery and keratitis onset ranged from 10 days to 2 years (10, 35, and 60 days, and 2 years).

Cultures were positive for Pseudomonas aeruginosa in two cases. Treatment included intensive fortified antibiotics for all patients. Irrigation was required in the intrastromal FSAK case after it eroded to the surface following a relapse of keratitis. One case required an emergency patch for fulminant corneoscleral melt, which enabled salvage of the eye.

Severe infectious keratitis can occur following uneventful FLACS with FSAK, even years after surgery. The wide onset range, from 10 days to 2 years postoperatively, underscores the need for long-term vigilance. Penetrating FSAK and incisions in the horizontal meridian appear to be potential risk factors. Prompt diagnosis and aggressive management, including intensive antibiotic therapy and surgical intervention when necessary, are crucial for preserving ocular integrity and optimizing outcomes.