title: Infectious keratitis outbreak after laser in situ keratomileusis at a single laser center in Japan.
abstract: OBJECTIVE
  To evaluate an outbreak of infectious keratitis after laser in situ keratomileusis (LASIK) at a single laser center in Japan.
  
  
  METHODS
  Tokyo Dental College, Chiba, Japan.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Relevant demographic and clinical data were obtained from case records using a standardized multicenter questionnaire at 12 major hospitals. The clinical manifestations, management, and outcomes were analyzed.
  
  
  RESULTS
  Thirty-nine eyes of 30 patients developed infectious keratitis after LASIK at the specified clinic. Cases of infection continued to appear over a 5-month period. The most common interval between LASIK and the onset of infection was within 2 weeks (36 eyes, 92.3%). Slitlamp manifestation included granular opacity beneath flap (71.8%), multiple infiltration (66.7%), and epithelial defect (30.8%). Mycobacterium was identified as the causative organism in 9 eyes (23.1%). In most cases, topical amikacin, arbekacin, and erythromycin in addition to fourth-generation fluoroquinolones were effective. Flap amputation was necessary in 10 eyes (25.6%) of 10 patients. Decimal visual acuity at initial presentation was worse than 0.10 in 14 eyes (35.9%), 0.15 to 0.50 in 8 eyes (20.5%), and 0.60 to 0.90 in 7 eyes (17.9%) and was better than 1.00 in 10 eyes (25.6%). Final decimal visual acuity was worse than 0.10 in 2 eyes (5.1%), 0.15 to 0.50 in 5 eyes (12.8%), and 0.60 to 0.90 in 11 eyes (28.2%) and was better than 1.00 in 21 eyes (53.8%).
  
  
  CONCLUSIONS
  Mycobacterium was identified as the causative organism of this outbreak. This study shows the possibility of an epidemic of post-LASIK infectious keratitis.
authors: Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan.
authors: Takefumi
authors: T
authors: Yamaguchi
authors: Hiroko
authors: H
authors: Bissen-Miyajima
authors: Yoshiko
authors: Y
authors: Hori-Komai
authors: Yukihiro
authors: Y
authors: Matsumoto
authors: Nobuyuki
authors: N
authors: Ebihara
authors: Hiroshi
authors: H
authors: Takahashi
authors: Kazuo
authors: K
authors: Tsubota
authors: Jun
authors: J
authors: Shimazaki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003320:Corneal Ulcer / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D016926:Mycobacterium chelonae / Q000302:isolation & purification*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D014792:Visual Acuity; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents