A rare case of infectious keratitis that developed 27-years after radial keratotomy.

Purpose: To report a rare case of bacterial infectious keratitis that developed 27 years after radial keratotomy.

Observations: A 48-year-old female who underwent bilateral radial keratotomy (RK) 27-years previous presented at our department with pain and visual loss in her right eye after being diagnosed with bacterial keratitis by her primary care physician. Slit-lamp examination showed a focus at the deep layer of the cornea, endothelial plaque, and hypopyon. Treatment with topical fortified levofloxacin and cefmenoxime eye drops was initiated. However, at 2 days after the initiation of treatment, there was no improvement, so anterior chamber irrigation and a bacterial smear/culture were performed. The smear showed many gram-positive cocci, yet no organism was detected in the culture. We suspected the causative bacteria to be methicillin-resistant Staphylococcus aureus (MRSA) due to her job (i.e., nursing staff) and the treatment course. Thus, we initiated treatment with 0.5% arbekacin eye drops for the suspected MRSA keratitis, and it was effectively controlled.

Conclusions And Importance: The findings in this case indicate that the incisions used for RK are delicate/fragile and can easily open doors to infection, as they remain unstable for many years post surgery.