ABSTRACT
PURPOSE: The authors report two cases of Mycobacterium keratitis following LASIK. METHODS: The case reports are based on a retrospective review of clinical history and associated findings. RESULTS: Two patients developed infectious keratitis after undergoing laser in situ keratomileusis (LASIK). In case #1, the infection developed after manipulation of the lamellar flap to remove epithelium from the stromal bed. In case #2, prior radial keratotomy may have been a contributing factor to development of the infection. Corneal infiltrates appeared as focal, white, stromal deposits. Cultures isolated Mycobacterium fortuitum from case #1 and Mycobacterium chelonae from case #2. Topical fortified amikacin, clarithromycin, tobramycin, and ciprofloxacin eventually controlled the infection. Topical prednisolone acetate and bandage contact lenses were necessary to control inflammation and pain. Infiltrates were slow to resolve until focal necrosis eroded through the flaps leading to rapid clearing of the infiltrates; however, scarring of the cornea developed at the site of necrosis. Visual recovery was good in the first case but limited in the second. CONCLUSIONS: Mycobacterium keratitis complicating LASIK may be difficult to eradicate until the sequestered stromal infiltrate drains. Rapid recognition of the causative organism and aggressive medical and surgical management of the infection may improve the outcome.
Subject(s)
Eye Infections, Bacterial/etiology , Keratitis/microbiology , Keratomileusis, Laser In Situ/adverse effects , Mycobacterium Infections, Nontuberculous/etiology , Mycobacterium chelonae/isolation & purification , Mycobacterium fortuitum/isolation & purification , Surgical Wound Infection/etiology , Adult , Anti-Bacterial Agents , Cornea/microbiology , Cornea/pathology , Drug Therapy, Combination/therapeutic use , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/pathology , Female , Glucocorticoids/therapeutic use , Humans , Keratitis/drug therapy , Keratitis/pathology , Male , Mycobacterium Infections, Nontuberculous/drug therapy , Mycobacterium Infections, Nontuberculous/pathology , Myopia/surgery , Ophthalmic Solutions , Surgical Wound Infection/drug therapy , Surgical Wound Infection/pathology , Visual Acuity , Wound HealingABSTRACT
A standardized nine-view photographic survey is presented (Fig. 12). Equipment, position of patient and photographer, placement of mirror and retractors, and position of the light source are described. The interest in and value of photographic documentation has increased, and a standardized survey offers many legal, organizational, and educational advantages.
