Mycobacterium interface keratitis after laser in situ keratomileusis.
OBJECTIVE
To report the clinical course, management, and outcome of infectious interface keratitis caused by mycobacterium species after laser in situ keratomileusis (LASIK).


METHODS
A small noncomparative interventional case series.


METHODS
Five eyes in four patients who underwent LASIK in different locations around the world and had culture-positive mycobacterium keratitis develop.


METHODS
The LASIK flap was lifted or amputated, samples were submitted for Ziehl-Neelsen acid-fast stain and Lowenstein-Jensen's agar cultures for diagnosis; topical treatment with fortified clarithromycin and amikacin was administered until clinical resolution.


METHODS
Time periods from onset to diagnosis and from diagnosis to clinical resolution, and the final visual acuity.


RESULTS
Onset of symptoms of infection occurred after a mean of 20 days (range, 11 days-6 weeks) after LASIK or an enhancement procedure. Definitive diagnosis was obtained after a mean period of 4.5 weeks (range, 12 days-8 weeks) from onset. Keratitis resolved within 8.4 weeks (range, 1-18 weeks) of treatment with fortified clarithromycin and amikacin. Corticosteroids were found to worsen and prolong the course of disease. In four of five eyes the LASIK flap was amputated.


CONCLUSIONS
Mycobacterial keratitis is a potentially vision-threatening complication after LASIK, characterized by a long latent period, delayed diagnosis, and a protracted course even under intensive specific antibiotic therapy. Inclusion of specific culture media and staining protocols for mycobacteria, along with aggressive treatment on diagnosis, including lifting or amputating the LASIK flap, culturing, topical fortified clarithromycin and amikacin, while avoiding corticosteroids, may significantly improve resolution of the infection and potentially improve the visual outcome.
Solomon
A
A
Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 17th Street, Miami, FL 33136, USA.
Karp
C L
CL
Miller
D
D
Dubovy
S R
SR
Huang
A J
AJ
Culbertson
W W
WW
D000328:Adult; D000583:Amikacin / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use; D003315:Cornea / Q000382:microbiology; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D016926:Mycobacterium chelonae / Q000302:isolation & purification; D013997:Time Factors
D000583:Amikacin; D017291:Clarithromycin