Background: Intrastromal corneal ring segments (ICRS) are used in the treatment of keratoconus. We report a case of microbial keratitis, occurring three months following ICRS implantation.
Methods: A 40 year old woman presented to our department with microbial keratitis in her left eye three months following bilateral ICRS insertion for keratoconus. Best corrected visual acuity (BCVA) was 1/60. Slit lamp examination revealed infiltrates around the superior ring segment and microcystic corneal edema. The fellow eye revealed ICRS with no pathology. Corneal scrapings were obtained for microscopy and cultures, and intensive treatment was commenced with topical antibiotics. The clinical picture worsened over next 24 hours with development of hypopyon. The ICRS were removed 48 hours after admission and sent for culture.
Results: The patient’s symptoms improved and the hypopyon resolved following implant removal. Staphylococcus epidermidis was isolated from the corneal scrapings. The patient was discharged on topical vancomycin, tobramycin and fluorometholone. At last review (12 weeks), BCVA was 1/60 with corneal stromal haze at the site of the implant.
Conclusions: Infection following implantation of ICRS is a rare but serious complication that can occur many months after the initial procedure. Once infection is suspected, removal of the implants may be considered.