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      Keratitis after Implantation of Intrastromal Corneal Rings with Spontaneous Extrusion of the Segment

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          Abstract

          Purpose

          To report a case of bacterial keratitis in a patient with a history of intrastromal corneal ring segments (INTACS®) implantation to correct keratoconus.

          Methods

          The patient's history, clinical presentation, pathological analysis and therapeutic management were reviewed.

          Results

          A 36-year-old-man was referred to our department due to decreased vision and intense pain in his left eye, 40 days after INTACS® implantation for keratoconus. Slit-lamp examination revealed epithelial defects and stromal infiltrates in the lower channel without evidence of the inferior ring. The anterior chamber also showed a significant fibrin reaction to hypopyon. A low-tension suture was removed at the site of the incision. Microbiological study of the conjunctival swab was positive for Staphylococcus epidermidis, but the corneal culture was sterile. The patient was treated with topical fortified and systemic antibiotics. The infection slowly resolved, leaving opacity at the inferior segment site.

          Conclusions

          Infectious keratitis following INTACS implantation is an infrequent complication that can have important consequences without suitable and early therapeutic management.

          Related collections

          Most cited references 6

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          Correcting keratoconus with intracorneal rings.

          To evaluate the potential of intrastromal corneal ring technology (Intacs, KeraVision) to correct keratoconus without central corneal scarring. Department of Ophthalmology, Brest University Hospital, Brest, France. In this prospective, noncomparative, interventional case series, Intacs segments were implanted in 10 keratoconic eyes with clear central corneas and contact lens intolerance after corneal pachymetry was checked. Segment thicknesses varied based on corneal topography analysis. No intraoperative complications occurred. The mean follow-up was 10.6 months. Postoperative results revealed a reduction in astigmatism and spherical correction and an increase in topographical regularity and increased uncorrected visual acuity. Intacs technology can reduce the corneal steepening and astigmatism associated with keratoconus.
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            Corneal infections after implantation of intracorneal ring segments.

            To report risk factors, clinical course, and outcome in patients with infectious keratitis following implantation of intracorneal ring segments (ICRS). The records of 8 patients with culture-proven infectious keratitis after ICRS (Ferrara or Intacs) implantation were retrospectively reviewed. Age, gender, corneal findings, ocular abnormalities, the condition that led to ICRS implantation, immediate prior use of a contact lens, elapsed time between implantation and the onset of symptoms, previous medications, and systemic disorders were noted. Culture-positive infectious keratitis developed in 7 eyes of 7 patients (2 men and 5 women) with a mean age of 35 years who underwent Ferrara implantation for the treatment of keratoconus and in a 29-year-old man who underwent Intacs implantation for correction of low myopia. Contact lens use, diabetes, and trauma were factors possibly associated with the risk of infection in three cases. Microorganisms, identified in all cases, included Staphylococcus aureus, Streptococcus viridans, Streptococcus pneumoniae, Pseudomonas sp, Nocardia sp, Klebsiella sp, and Paecylomices sp. Onset of symptoms of infection varied from less than 1 week to 22 months postoperatively, depending on the infecting organism. Infectious keratitis following ICRS implantation is a sight-threatening complication for which early recognition and rapid institution of appropriate treatment may result in a better visual outcome.
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              Late bacterial keratitis after implantation of intrastromal corneal ring segments.

              We report a case of bacterial keratitis that occurred after implantation of intrastromal corneal ring segments (Intacs). The patient presented with decreased vision, inflammation, and stromal infiltrates localized at the extremity of an Intacs channel 3 months after surgery. Culture were positive for Clostridium perfringens and Staphylococcus epidermidis. The infiltrates progressed despite treatment with topical fortified and systemic antibiotics. The Intacs were removed. The keratitis slowly resolved, and the patient recovered a best corrected visual acuity of 20/20.
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                Author and article information

                Journal
                Case Report Ophthalmol
                COP
                Case Reports in Ophthalmology
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch )
                1663-2699
                Sep-Dec 2010
                13 September 2010
                13 September 2010
                : 1
                : 2
                : 42-46
                Affiliations
                Department of Ophthalmology, ‘Lozano Blesa’ University Clinic Hospital, Zaragoza, Spain
                Author notes
                *Juan Ibáñez-Alperte, MD, Department of Ophthalmology, ‘Lozano Blesa’ University Clinic Hospital, ES-50010 Zaragoza (Spain), Tel. +34 665 802 084, Fax +34 976 667 300, E-Mail juanibanezalperte@ 123456msn.com
                Article
                cop0001-0042
                10.1159/000320585
                2974971
                21060771
                Copyright © 2010 by S. Karger AG, Basel

                © 2010 S. Karger AG, Basel. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial-No-Derivative-Works License ( http://creativecommons.org/licenses/by-nc-nd/3.0/). Users may download, print and share this work on the Internet for noncommercial purposes only, provided the original work is properly cited, and a link to the original work on http://www.karger.com and the terms of this license are included in any shared versions.

                Page count
                Figures: 2, References: 6, Pages: 5
                Categories
                Published: September 2010

                Ophthalmology & Optometry

                intacs®, keratitis, intrastromal rings, segment extrusion

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