Endophthalmitis and orbital cellulitis after radial keratotomy

Purpose: To report the findings concerning three patients with endophthalmitis and one with panophthalmitis and orbital cellulitis radial keratotomy surgery. Methods: One man referred with panophthalmitis and orbital cellulitis and three women referred with endophthalmitis were treated. Results: After radial keratotomy surgery, during which no microperforation or macroperforation had been reported, a severe Pseudomonas panophthalmitis and orbital cellulitis developed in the man. All vision was lost in that eye. Staphylococcus epidermidis endophthalmitis developed in one woman, Streptococcus pneumoniae endophthalmitis in the second woman and Pseudomonas endophthalmitis in the third woman, after undergoing radial keratotomy procedures during which microperforations occurred. In the latter patient, bilateral simultaneous surgery was performed, but only one eye became infected. The latter two infections resulted in light perception and hand motion vision respectively, In three cases, an initial keratitis was located in the inferior cornea. Conclusions: Severe bacterial endophthalmitis can occur after radial keratotomy surgery, even in the absence of microperforation during the procedure. Any evidence of postoperative keratitis must be regarded seriously and treated aggressively. Despite use of this approach, the effect on final visual acuity can be devastating.