Rare but Serious: Infectious Keratitis After Femtosecond Laser-Assisted Arcuate Keratotomies in Cataract Surgery: A Case Series and Review of Literature.

PURPOSE To present five cases of infectious keratitis following femtosecond laser-assisted cataract surgery combined with laser arcuate keratotomies (FLACS-AK).

METHODS This was a retrospective review of the medical records of five patients who developed infectious keratitis after FLACS-AK, including medical history, clinical findings, surgical details, microbiological culture results, and imaging. Review of the literature revealed only two other published cases describing infectious keratitis following FLACS-AK.

RESULTS All patients underwent uneventful FLACS-AK in both eyes and later developed unilateral infectious keratitis at the arcuate keratotomy incision. One patient developed an early-onset, fulminant infection with cultures positive for Pseudomonas aeruginosa. Two patients presented with late-onset, milder infections, with negative culture results. Two patients developed a very late-onset infection due to P. aeruginosa, with one of them requiring surgical intervention. All patients were also treated with fortified antibiotics. Four of five patients had good clinical and visual outcomes, whereas one patient suffered from devastating results.

CONCLUSIONS Infectious keratitis following FLACS-AK is a rare but potentially sight-threatening complication with variable onset and severity. Penetrating arcuate keratotomies may pose a higher risk of infection compared to intrastromal incisions, underscoring the need for careful surgical planning and long-term postoperative surveillance. Surgeons should therefore consider performing an intrastromal incision or, when applicable, a different method for arcuate correction.