2001 Ocular Microbiology and Immunology Group, Abstract 20

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A Cluster of Mycobacterium chelonae Keratitis Cases Associated with Laser in-situ Keratomileusis
N.S. Chandra, M.F. Torres, K. Winthrop, B.J. Mondino, D.G. Heidemann,, D. Bruckner and G.N. Holland
Jules Stein Eye Institute, UCLA School of Medicine, Los Angeles, CA

Purpose: To describe a cluster of Mycobacterium chelonae keratitis cases involving patients who underwent laser in-situ keratomileusis (LASIK) at a single refractive surgery center.

Methods: Case series of four patients. Clinical characteristics, diagnostic tests, and response to treatment are reported. We investigated the source and possible surgical factors associated with development of infection.

Results: Seven of eight eyes in the four patients developed infectious keratitis. All patients underwent bilateral hyperopic LASIK using the NIDEK excimner laser and a central masking technique with trephinated contact lenses. Surgery was performed on two consecutive days by one surgeon in a community-based refractive surgery center. All seven eyes were noted to have granular infiltrates between two and fourteen days after the procedure, which were initially thought to be manifestations of difffuse lamellar keratitis. These findings progressed in all eyes to dense corneal stromal infiltrates over a period of two weeks. Corneal scrapings obtained from all seven eyes after lifting lamellar keratectomy flaps grew M.chelonae subspecies chelonae on Middlebrook culture media. All seven eyes were treated with a combination of topical antimicrobial agents including amikacin, ciprofloxacin, and clarithromycin.

Infection resolved in all eyes over a period of four to ten weeks, after addition of topical azithromycin to treatment regimens for five eyes in three patients. Two eyes in two patients required removal of the lamallar keratectomy flap. Varying degrees of corneal scarring and vascularization occurred in all seven eyes. The source of infection was not identified.

Conclusion: Post-operative infectious keratitis caused by atypical mycobacteria can occur in an epidemic fashion following LASIK. Topical azithromycin may be an effective agent for treatment of these infections.

Grant/Financial Support: Research to Prevent Blindness, Inc.

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