Infectious Ulcerative Keratitis Following Retinopathy of Prematurity Treatment

• Published in: Journal of pediatric ophthalmology and strabismus Vol. 52; no. 4; pp. 221 - 225
• Main Authors: Modi, Kunjal K, Chu, David S, Wagner, Rudolph S, Guo, Suqin, Zarbin, Marco A, Bhagat, Neelakshi
• Format: Journal Article
• Language: English
• Published: United States SLACK INCORPORATED 01.07.2015
• Subjects: Anti-Bacterial Agents - therapeutic use; Bacteria - isolation & purification; Cornea - immunology; Corneal Ulcer - diagnosis; Corneal Ulcer - drug therapy; Corneal Ulcer - microbiology; Eye diseases; Eye Infections, Bacterial - diagnosis; Eye Infections, Bacterial - drug therapy; Eye Infections, Bacterial - microbiology; Eye surgery; Female; Gestational Age; Humans; Infant; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature; Laser Coagulation; Male; Ophthalmology; Pediatrics; Postoperative Complications; Retinopathy of Prematurity - surgery; Retrospective Studies; Vitrectomy
• ISSN: 0191-3913; 1938-2405
• DOI: 10.3928/01913913-20150602-01

Purpose: To report the complication of infectious ulcerative keratitis after laser photocoagulation and pars plana vitrectomy (PPV) for retinopathy of prematurity (ROP). Methods: A retrospective chart review of infants treated for ROP with plus disease between 2004 and 2013 at University Hospital, Newark, New Jersey. Results: Of the 110 eyes (55 patients) that underwent treatment for ROP, 8 (7.27%) eyes were noted to develop infectious ulcerative keratitis in 4 neonates (4 eyes after laser photocoagulation and 4 eyes after PPV). All 8 eyes that developed ulcerative keratitis had a preceding corneal epithelial defect followed by corneal stromal haze. Seven of 8 eyes developed epithelial defect within 8 days of the procedure. All epithelial defects progressed to ulcerative keratitis within 7 days. A total of 10 (9.1%) eyes developed postoperative epithelial defects, and 8 (80%) of these eyes were ultimately diagnosed as having ulcerative keratitis. Four (4.08%) of 98 eyes treated with laser photocoagulation alone developed infective ulcerative keratitis, compared to 4 (33.33%) of 12 eyes treated with PPV. Because keratitis healed, corneal opacification ensued and covered 10% to 90% of the corneal surface area. Five of the 8 eyes had positive culture of corneal scrapings: 2 grew coagulase-negative Of the 110 eyes (55 patients) that underwent treatment for ROP, 8 (7.27%) eyes were noted to develop infectious ulcerative keratitis in 4 neonates (4 eyes after laser photocoagulation and 4 eyes after PPV). All 8 eyes that developed ulcerative keratitis had a preceding corneal epithelial defect followed by corneal stromal haze. Seven of 8 eyes developed epithelial defect within 8 days of the procedure. All epithelial defects progressed to ulcerative keratitis within 7 days. A total of 10 (9.1%) eyes developed postoperative epithelial defects, and 8 (80%) of these eyes were ultimately diagnosed as having ulcerative keratitis. Four (4.08%) of 98 eyes treated with laser photocoagulation alone developed infective ulcerative keratitis, compared to 4 (33.33%) of 12 eyes treated with PPV. Because keratitis healed, corneal opacification ensued and covered 10% to 90% of the corneal surface area. Five of the 8 eyes had positive culture of corneal scrapings: 2 grew coagulase-negative Staphylococcus and Stenotrophamonas ; 1 grew coagulase-negative Staphylococcus ; 1 grew Streptococcus viridans , and 1 grew Staphylococcus hominis , Streptococcus mitis , and Streptococcus viridans . All 8 eyes were treated with antibiotic eye drops. Conclusions: Infectious ulcerative keratitis developed in a small, but significant, percentage of patients undergoing treatment for ROP. Postoperative corneal epithelial defects with subsequent corneal haze appear to be involved in the progression to ulcerative keratitis. [[ J Pediatr Ophthalmol Strabismus . 2015;52(4):221–225.]