An outbreak of Mycobacterium chelonae infection after LASIK.
OBJECTIVE
To describe an outbreak of mycobacterial keratitis after laser in situ keratomileusis (LASIK), including the microbiologic investigation, clinical findings, treatment response, and outcome.


METHODS
Retrospective, noncomparative, interventional case series.


METHODS
Patients (n = 10) who underwent LASIK surgery between August 22 and September 4, 2000, and developed mycobacterial infection.


METHODS
Patients were prospectively followed in relation to microbiologic investigation, clinical findings, treatment response, and outcome.


METHODS
Most patients underwent bilateral simultaneous LASIK. Postoperative infection was signaled by the appearance of corneal infiltrates in the third postoperative week. The microbiologic workup was performed on cultures obtained either by direct scraping of the cornea or by lifting the flap. Medical therapy was instituted based on drug susceptibility testing. Surgical interventions such as corneal debridement and flap removal were performed during recurrences or when there was no satisfactory clinical response.


RESULTS
Cultures revealed Mycobacterium subspecies chelonae. Patients were treated with topical clarithromycin (1%), tobramycin (1.4%), and ofloxacin (0.3%). Oral clarithromycin (500 mg twice a day) was prescribed for those patients who did not respond clinically to topical treatment. Four eyes healed on this regimen. Flap removal was necessary in seven eyes.


CONCLUSIONS
This report highlights mycobacteria as an etiologic infectious agent after LASIK. Diagnosis can be difficult and is often delayed. The treatment mainstay is prolonged antibiotic therapy. Surgical debridement and flap removal may shorten the disease course.
Freitas
Denise
D
Ophthalmology Department, Federal University of São Paulo, Paulista School of Medicine, São Paulo Hospital, Rua Botucatu 822, 04023-062 São Paulo, Brazil. dfreitas@pobox.com
Alvarenga
Lênio
L
Sampaio
Jorge
J
Mannis
Mark
M
Sato
Elcio
E
Sousa
Luciene
L
Vieira
Luiz
L
Yu
Maria C
MC
Martins
Maria C
MC
Hoffling-Lima
Ana
A
Belfort
Rubens
R
D000328:Adult; D000900:Anti-Bacterial Agents; D001938:Brazil / Q000453:epidemiology; D003131:Combined Modality Therapy; D003315:Cornea / Q000382:microbiology; D003646:Debridement; D004196:Disease Outbreaks; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D015818:Eye Infections, Bacterial / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007634:Keratitis / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D016926:Mycobacterium chelonae / Q000302:isolation & purification*; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents