[Diagnosis and treatment of mycobacterial keratitis following LASIK. Case report and review of the literature].
BACKGROUND
Mycobacterial keratitis is a rare complication following LASIK but can lead to an extremely unfavourable outcome. The diagnosis and treatment is often delayed due to confusion with other entities including diffuse lamellar keratitis and poor clinical outcomes with flap amputation and/or keratoplasty are often the case.


METHODS
We report the results of LASIK in a 51-year-old woman with subsequent early-diagnosed mycobacterial keratitis and compared this case to treatments and outcomes reported in the literature.


RESULTS
The patient presented 10 days following LASIK with a white focal infiltrate in the stromal interface. The flap was lifted and cultures from the stromal bed and the reverse of the flap were obtained and the interface irrigated. The patient was treated with topical antibiotics (ciprofloxacin 0.3%, amikacin 2.5%, clarithromycin 40 mg/ml and tobramycin 15 mg/ml) for 8 weeks and at the most recent follow-up she had a visual acuity of 1.25.


CONCLUSIONS
In a large number of published cases in the literature the flap had to be amputated and/or corneal transplants were necessary. Early diagnosis and treatment however, are essential to successfully treat post-LASIK keratitis. Therefore the patients should be followed up carefully in the early postoperative period.
Holzer
M P
MP
Heidelberger Forschungsgruppe Refraktive Laser- und Intraokularlinsenchirurgie, Universitäts-Augenklinik, Heidelberg. mike_holzer@med.uni-heidelberg.de
Solomon
K D
KD
Sandoval
H P
HP
Auffarth
G U
GU
D000900:Anti-Bacterial Agents; D000904:Antibiotics, Antitubercular / Q000008:administration & dosage; D001431:Bacteriological Techniques; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000904:Antibiotics, Antitubercular