Infectious Ulcerative Keratitis Following Retinopathy of Prematurity Treatment.

PURPOSE To report the complication of infectious ulcerative keratitis after laser photocoagulation and pars plana vitrectomy (PPV) for retinopathy of prematurity (ROP). METHODS A retrospective chart review of infants treated for ROP with plus disease between 2004 and 2013 at University Hospital, Newark, New Jersey. RESULTS Of the 110 eyes (55 patients) that underwent treatment for ROP, 8 (7.27%) eyes were noted to develop infectious ulcerative keratitis in 4 neonates (4 eyes after laser photocoagulation and 4 eyes after PPV). All 8 eyes that developed ulcerative keratitis had a preceding corneal epithelial defect followed by corneal stromal haze. Seven of 8 eyes developed epithelial defect within 8 days of the procedure. All epithelial defects progressed to ulcerative keratitis within 7 days. A total of 10 (9.1%) eyes developed postoperative epithelial defects, and 8 (80%) of these eyes were ultimately diagnosed as having ulcerative keratitis. Four (4.08%) of 98 eyes treated with laser photocoagulation alone developed infective ulcerative keratitis, compared to 4 (33.33%) of 12 eyes treated with PPV. Because keratitis healed, corneal opacification ensued and covered 10% to 90% of the corneal surface area. Five of the 8 eyes had positive culture of corneal scrapings: 2 grew coagulase-negative Staphylococcus and Stenotrophamonas; 1 grew coagulase-negative Staphylococcus; 1 grew Streptococcus viridans, and 1 grew Staphylococcus hominis, Streptococcus mitis, and Streptococcus viridans. All 8 eyes were treated with antibiotic eye drops. CONCLUSIONS Infectious ulcerative keratitis developed in a small, but significant, percentage of patients undergoing treatment for ROP. Postoperative corneal epithelial defects with subsequent corneal haze appear to be involved in the progression to ulcerative keratitis.