title: Mycobacterium chelonae-Mycobacterium abscessus complex clear corneal wound infection with recurrent hypopyon and perforation after phacoemulsification and intraocular lens implantation.
abstract: We report a clear corneal wound infection occurring in a 74-year-old man caused by a member of the Mycobacterium chelonae-Mycobacterium abscessus complex, presenting as crystalline keratopathy with recurrent hypopyon. This led to perforation after phacoemulsification with posterior chamber intraocular lens implantation. Only after corneal biopsy of the incision was the causative organism isolated and found to be sensitive to clarithromycin and ciprofloxacin. Despite aggressive therapy, a full-thickness corneal perforation developed, requiring emergent cyanoacrylate glue to preserve ocular integrity. Both the difficulty and delays in obtaining a correct diagnosis led to severe ocular morbidity. Infectious lamellar keratitis limited to the clear cornea phacoemulsification incision is rare, but some unusual organisms such as atypical mycobacteria may be encountered.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Juan Javier
authors.initials: JJ
authors.lastname: Servat
authors.forename: Jerome C
authors.initials: JC
authors.lastname: Ramos-Esteban
authors.forename: Shachar
authors.initials: S
authors.lastname: Tauber
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Bia
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D003487:Cyanoacrylates / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008826:Microbial Sensitivity Tests; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D016926:Mycobacterium chelonae / Q000302:isolation & purification*; D018918:Phacoemulsification; D012008:Recurrence; D012422:Rupture, Spontaneous; D013492:Suppuration / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D014014:Tissue Adhesives
chemical_list: D000900:Anti-Bacterial Agents; D003487:Cyanoacrylates; D014014:Tissue Adhesives