Topical Antibiotic Treatment Combined with Corneal Lavage for Acute Interface Bacterial Infection after SMILE: A Case Series

Lin Zhao#, Chang Liu#, Mingwu Wang*, Jie Bai, Ling Li, Zexia Dou, Shaowei Li*

1Aier Academy of Ophthalmology, Central South University, Changsha, P.R. China 2Department of Cornea, Beijing Aier-Intech Eye Hospital, Beijing, P.R. China 3Aier Cornea Institute, Beijing, P.R. China 4Aier Eye Hospital, Jinan University, Guangzhou, P.R. China 5Department of Ophthalmology, University of Arizona College of Medicine, Tucson, the United States #The first two authors contribute equally

^*Correspondance to: Shaowei Li, Mingwu Wang 

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Abstract:

Background: Various therapeutic approaches have been used to treat bacterial infections following SMILE procedures. While interface irrigation and debridement typically serve as primary treatments, these methods carry a risk of corneal lamellar flap rupture during debridement - a complication that could significantly compromise visual outcomes. This study presents a novel combined treatment strategy for achieving rapid control of post-SMILE bacterial infections. Methods: A retrospective chat review was conducted of interface bacterial infections following SMILE treated in our institution between June 2019 and October 2021. Our treatment protocol mainly included topical administration and corneal lavage of antibiotics, as well as photoactivated chromophore for keratitis-corneal cross-linking (CXL). Key interventions contributing to rapid eradication of infections were analyzed. Results: 7 eyes of four patients with interface bacterial infections following SMILE were treated. All 7 eyes received topical and corneal lavage of vancomycin/tobramycin. Additionally, 6 eyes received CXL and 1 eye interface antibiotic irrigation. Without knowing causal pathogens, continuous lavage accelerated the clearance of the infections. Time taken to control the infections in this case series ranged from 1 to 8 days (median 4 days), and time taken to achieve clinical cure from 5 to 15 days (median 7 days), with the best corrected visual acuity ≥20/25 at the last follow-up. Conclusions: Combining topical antibiotics with continuous corneal lavage can quickly control interface bacterial infections after SMILE and preserve vision. CXL appears to have limited additional therapeutic effect.

Keywords:

Corneal refractive surgery; Post-SMILE infection; Corneal lavage; Corneal crosslinking

Cite the Article:

Zhao L, Liu C, Wang M, Bai J, Li L, Dou Z, et al. Topical Antibiotic Treatment Combined with Corneal Lavage for Acute Interface Bacterial Infection after SMILE: A Case Series. Ann Clin Case Rep. 2025; 10: 2766..