Recalcitrant post-LASIK Mycobacterium chelonae keratitis eradicated after the use of fourth-generation fluoroquinolone.
OBJECTIVE
To report a patient with Mycobacterium chelonae keratitis after LASIK and discuss therapeutic measures.


METHODS
Interventional case report and literature review.


METHODS
A healthy, 25-year-old man presented 6 weeks after LASIK with infectious keratitis in the left eye. Scrapings were obtained from the central stromal bed after lifting the flap and inoculated on culture media.


METHODS
Response to medical treatment.


RESULTS
Mycobacterium chelonae was identified from stromal bed scrapings. The protracted course of the infection necessitated surgical debridement and flap amputation with slow and suboptimal response to prolonged (14 weeks) treatment with topical amikacin 3.3%, clarithromycin 1%, and levofloxacin 0.5%. The substitution of levofloxacin 0.5% with gatifloxacin 0.3% resulted in closure of the epithelial defect within 1 week and resolution of the infiltrates in 3 weeks. The combined regimen of gatifloxacin 0.3%, amikacin 3.3%, and clarithromycin 1% was continued for a total of 4 months. The patient remains infection free 1 year after stopping all antibiotics.


CONCLUSIONS
Treatment of post-LASIK nontuberculous mycobacteria remains a challenge. Institution of combination therapy including fortified amikacin, clarithromycin 1%, and a fourth-generation fluoroquinolone appeared to be beneficial in this patient.
Hamam
Rola N
RN
Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon.
Noureddin
Baha
B
Salti
Haytham I
HI
Haddad
Randa
R
Khoury
Johnny M
JM
D000328:Adult; D000583:Amikacin / Q000008:administration & dosage / Q000627:therapeutic use; D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017291:Clarithromycin / Q000008:administration & dosage / Q000627:therapeutic use; D003319:Corneal Stroma / Q000382:microbiology / Q000601:surgery; D003646:Debridement; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D024841:Fluoroquinolones / Q000008:administration & dosage / Q000627:therapeutic use; D000077734:Gatifloxacin; D006801:Humans; D007634:Keratitis / Q000188:drug therapy* / Q000382:microbiology; D020731:Keratomileusis, Laser In Situ; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy* / Q000382:microbiology; D016926:Mycobacterium chelonae / Q000187:drug effects*; D009883:Ophthalmic Solutions / Q000008:administration & dosage / Q000627:therapeutic use; D011183:Postoperative Complications; D013524:Surgical Flaps
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D009883:Ophthalmic Solutions; D000583:Amikacin; D017291:Clarithromycin; D000077734:Gatifloxacin