Drug-Resistant Bacteria Poses Growing Threat to LASIK Patients

For as long as LASIK has been performed, there have been complications following this very popular refractive surgery procedure including ectasia and buttonhole flaps. While these two post-LASIK conditions have been quite worrisome to LASIK surgeons, there is a new, and much more serious, sometimes fatal, complication looming.

First Time in LASIK's History



A report published in the April 2007 issue of the American Journal of Ophthalmology has indicated (for the first time in LASIK history) a risk of Methicillin-resistant Staphylococcus aureus (MRSA) keratitis following LASIK surgery. Many healthy people carry staph bacteria in their noses without ever getting sick, but when someone's skin is cut, punctured or broken, staph bacteria can enter the wound and cause infections, sometimes very serious, leading to other health problems. The staph bacteria can cause a range of illnesses from minor skin infections to life-threatening disease such as meningitis, endocarditis, toxic shock syndrome, and pneumonia.

In their study, doctors Renee Solomon and Eric Donnenfeld of Rockville Centre, New York, warned:

"MRSA keratitis is a serious and increasing complication following refractive surgery. Patients with exposure to a healthcare environment should be considered at additional risk for developing MRSA keratitis…surgeons should now be vigilant for community-acquired MRSA."

Increased Risk with Healthcare Setting Exposure

In the study, the MRSA keratitis patients were overwhelmingly ones who had contact with healthcare settings and included a hospital lab technician and the spouse of a nursing home worker. However, three of the patients in the study denied any exposure to a healthcare environment. Most patients in the study had undergone LASIK but two had undergone Photorefractive keratectomy (PRK). All patients in the study presented with a decrease in visual acuity and pain or irritation in the affected eye between 2 and 10 days following the procedure. The majority of patients in the study had been prescribed older-generation antibiotics and experienced no relief.

Dr. Solomon, in the study, emphasizes the warning, "MRSA infectious keratitis is a potentially serious complication following refractive surgery."

Bacterial Resistance and Corneal Scarring

MRSA typically occurs early, within 10 days following the LASIK or PRK procedures and, at this time, the incidence of MRSA keratitis following refractive surgery is low but increasing quickly. The cases of MRSA keratitis seen thus far have been serious due to the bacteria's resistance to traditional, older-generation antibiotics. One 48-year-old male nurse experienced symptoms just two days after surgery and sought medical treatment immediately after he felt pain and foreign body sensation in his left eye. After taking antibiotics for weeks, the patient was diagnosed as having MRSA keratitis, but by then, he had suffered corneal scarring.

Corneal scarring, when dense enough to affect vision, may result in the need for a corneal transplant. Corneal transplant is used when vision is lost because the cornea is damaged by disease or traumatic injury, and transplants are used only when damage to the cornea is too severe to be treated with corrective lenses.

The cases of MRSA keratitis reported in the April issue of the American Journal of Ophthalmology are the first reports of the infection after antibiotic prophylaxis (medication used to prevent infections). Strains of MRSA are emerging rapidly amongst those having had LASIK refractive surgery and those strains are demonstrating multiple drug resistance. According the journal, "Community-acquired MRSA is becoming a significant problem, with the prevalence of MRSA among community isolates expected to reach as high as 25% in the next decade."