Topical Linezolid 0.2% for the Treatment of Vancomycin-Resistant or Vancomycin-Intolerant Gram-Positive Bacterial Keratitis

PurposeTo report the successful use of topical linezolid 0.2% in the treatment of gram-positive bacterial keratitis.Study DesignRetrospective, interventional case series.MethodsAll cases of bacterial keratitis treated at the University of Illinois Eye and Ear Infirmary with topical linezolid were identified from the Cornea and External Disease Clinic and were reviewed for culture results, prior therapy, clinical course, and visual outcome.ResultsThree patients received topical linezolid, all for cases of culture-positive or presumed gram-positive keratitis. Cases consisted of 1 patient with recalcitrant vancomycin-resistant Enterococcus faecalis (VRE) and 2 patients with infectious crystalline keratitis, 1 previously culture-positive for an uncharacterized Staphylococcus and the other for Streptococcus mitis. All 3 patients had rapid resolution of their infectious keratitis and noted no pain or discomfort attributed to the topical therapy. The patient with VRE keratitis developed a consecutive Candida keratitis elsewhere in the same cornea at the end of therapy for her VRE keratitis.ConclusionTopical linezolid 0.2% can be an effective ophthalmic antibiotic for the treatment of gram-positive keratitis, including VRE, and is both significantly more comfortable and less immediately toxic to the ocular surface than topical vancomycin.