Microbial keratitis identified during eye bank screen of corneoscleral tissue harvested from patients with laser in situ keratomileusis history.

Laser-assisted in situ keratomileusis (LASIK) has become a wellaccepted and effective procedure for the treatment of a wide range of refractive errors. Microbial keratitis is a potential complication of LASIK with causative organisms, including gram-positive bacteria, atypical mycobacteria, fungi, and viral pathogens. Direct ocular trauma and exposure keratopathy in severely ill patients in intensive care units are risk factors for microbial keratitis. We describe the first cases, to our knowledge, of infectious keratitis in donor corneas harvested from cadavers with a past history of LASIK. Slitlamp, specular microscopy, and histopathologic findings are presented. These donors would likely have suffered vision loss if they had survived their illnesses. This article illustrates the importance of eye care by intensive care personnel managing patients with a past history of LASIK. Report of Cases. Case 1. In December 2002, a healthy 22-year-old man underwent uncomplicated myopic LASIK in both eyes. Two days later, he was involved in a highspeed motor vehicle crash; he sustained diffuse brain injury. He was maintained on life support for 1 week and was evaluated for organ donation. During his hospitalization, the patient received tobramycin and dexamethasone drops. Death-to-preservation time for in situ corneal excision was 6 hours 48 minutes. The donor corneas were placed in Optisol-GS cornea storage media (Chiron Ophthalmics, Irvine, Calif) and sent to the New Mexico Lions Eye Bank (Albuquerque), using protocols established by the Eye Bank Association of America. On slitlamp examination, the right donor cornea had an obvious LASIK flap with localized flap dehiscence and folds (Figure 1A). This cornea had evidence of an infiltrate with feathery edges (Figure 1B). The left donor cornea also had a poorly healed LASIK flap edge and a more extensive corneal infiltrate (Figure 2). Specular microscopy performed 4 days after death revealed central endothelial cell counts of 2008/mm in the right cornea and 2159/mm in the left cornea. Highly reflective particles were seen in both donor corneas when the specular microscope was focused in the region of the stroma corresponding to the LASIK interface. The donor corneas were then placed in 10% neutral buffered formalin and processed for permanent sections. Sections were stained with hematoxylin-eosin, periodic acid–Schiff, Brown and Brenn, and Gomori methenamine silver. Histo-