title: An outbreak of Mycobacterium chelonae infection after LASIK.
abstract: 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.
authors.affiliation: 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
authors.forename: Denise
authors.initials: D
authors.lastname: Freitas
authors.forename: Lênio
authors.initials: L
authors.lastname: Alvarenga
authors.forename: Jorge
authors.initials: J
authors.lastname: Sampaio
authors.forename: Mark
authors.initials: M
authors.lastname: Mannis
authors.forename: Elcio
authors.initials: E
authors.lastname: Sato
authors.forename: Luciene
authors.initials: L
authors.lastname: Sousa
authors.forename: Luiz
authors.initials: L
authors.lastname: Vieira
authors.forename: Maria C
authors.initials: MC
authors.lastname: Yu
authors.forename: Maria C
authors.initials: MC
authors.lastname: Martins
authors.forename: Ana
authors.initials: A
authors.lastname: Hoffling-Lima
authors.forename: Rubens
authors.initials: R
authors.lastname: Belfort
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents