In a groundbreaking study spanning 13 years, researchers at Khalili Hospital in Shiraz, Iran, have detailed the troubling rise in cases of infectious keratitis following photorefractive keratectomy (PRK) surgery. This retrospective study, conducted from June 2011 to March 2024, followed strict ethical guidelines and received the necessary approvals, ensuring the integrity of its findings.

The study focused on individuals who developed infectious keratitis after undergoing PRK. Out of nearly 39,000 surgical procedures performed, an alarming rate of 0.018% or seven cases led to this serious complication, raising concerns about the safety of PRK procedures.

Study Breakdown: The Two-Stage Approach

Researchers followed a two-pronged approach: - Stage 1 documented the incidence of infectious keratitis post-PRK. - Stage 2 analyzed clinical features, treatments, and patient outcomes, broadening the focus to include all affected individuals, irrespective of where their surgery had occurred.

Patients diagnosed with infectious keratitis who had at least six months of follow-up were included in the study, which analyzed risk factors such as age, gender, microbial cultures, and visual acuity outcomes.

Why Are Cases Spiking?

Among the 42 patients diagnosed with infectious keratitis, the average age was 28.74 years, with a slight male predominance. Notably, 26 of the cases presented within a week post-surgery, emphasizing the urgency the medical community faces in monitoring post-operative patients.

During the COVID-19 pandemic, the incidence of infectious keratitis surged, with a startling infection rate of 0.13%. This represents a strategic increase compared to a lower rate of 0.02% pre-pandemic, indicating that masks and hygiene could have inadvertently contributed to the heightened risk.

The study identified various pathogens responsible for infections, pinpointing that early-onset infections were primarily caused by Staphylococcus bacteria, while later infections frequently involved fungal agents or Acanthamoeba. The revelation that over 70% of culture tests returned positive for infectious agents underlines the need for greater vigilance among healthcare practitioners and patients alike.

Visual Recovery: A Mixed Bag

While treatments like fortified antibiotic therapies were broadly effective, leading to improved visual outcomes for almost all but one patient, the overall visual acuity figures showed that nearly half of the affected individuals achieved a corrected distance visual acuity (CDVA) of better than 5/10 post-treatment. The dire need for early intervention became apparent as two cases developed endophthalmitis, necessitating urgent surgical procedures.

Management and Future Outlook

Managing post-PRK infectious keratitis involves a careful selection of empirical antibiotics, emphasizing the need for exhaustive clinical assessments before surgery. This study corroborates the risks involved with inadequate monitoring and highlights potential risk factors such as contact lens use, pre-existing conditions, and environmental factors.

With ongoing concerns about the rise in keratitis cases, the medical community is urged to implement stricter monitoring protocols and early intervention strategies, especially in the COVID-19 era where altered hygiene practices could have unforeseen consequences.

As this comprehensive study illuminates critical issues surrounding PRK safety, it strongly advocates for both practitioners and patients to be more aware of the signs of complications. The ongoing battle against infectious keratitis following PRK indicates a pressing need for further studies to ensure the safety and success of refractive surgeries moving forward.

In conclusion, while PRK surgery remains a widely accepted method for vision correction, its associated risks require heightened awareness and proactive management to prevent potential severe outcomes.