title: Bacillus megaterium delayed onset lamellar keratitis after LASIK.
abstract: OBJECTIVE
  To report the history and clinical presentation of a 23-year-old man who developed delayed onset lamellar keratitis in his right eye 2 weeks after uneventful LASIK for correction of myopia.
  
  
  METHODS
  Initial clinical presentation suggested an infectious etiology, which led to therapeutic elevation of the LASIK flap and further microbiologic investigation with bacterial cultures.
  
  
  RESULTS
  Bacterial cultures revealed Bacillus megaterium, which was sensitive to all antibiotics against which it was tested. Twenty-four hours after initiating aggressive topical and oral antibiotic therapy, symptomatic relief occurred in the affected eye. The patient's uncorrected final visual acuity at 1-year follow-up was 20/15 in the right eye, and the stromal bed developed a faint peripheral non-visually significant scar.
  
  
  CONCLUSIONS
  This case is an unusual presentation and course for microbial keratitis following LASIK, which occurred despite aseptic technique and fluoroquinolone antibiotic prophylaxis. Following refractive surgery one should be prepared to culture the lamellar interface in cases of suspected microbial keratitis and begin aggressive antibiotic therapy.
authors.affiliation: Department of Ophthalmology, Yale University School of Medicine, New Haven, Conn, USA.
authors.forename: Jerome C
authors.initials: JC
authors.lastname: Ramos-Esteban
authors.forename: Juan Javier
authors.initials: JJ
authors.lastname: Servat
authors.forename: Shachar
authors.initials: S
authors.lastname: Tauber
authors.forename: Frank
authors.initials: F
authors.lastname: Bia
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001410:Bacillus megaterium / Q000302:isolation & purification*; D003315:Cornea / Q000382:microbiology; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000382:microbiology*; D005500:Follow-Up Studies; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D007634:Keratitis / Q000188:drug therapy / Q000382:microbiology*; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008297:Male; D009883:Ophthalmic Solutions; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D009883:Ophthalmic Solutions