Achromobacter xylosoxidans keratitis masquerading as recurrent erosion after LASIK.
OBJECTIVE
To describe the clinical stages and management of Achromobacter xylosoxidans keratitis with post-LASIK epithelial ingrowth in two patients.


METHODS
Retrospective chart review.


RESULTS
Both patients had been treated with topical antibiotics and corticosteroids for several weeks prior to presentation. Examination at presentation revealed significant areas of epithelial ingrowth without signs of acute inflammation, prompting an erroneous initial diagnosis of recurrent corneal erosion. A corneal infiltrate was eventually observed and A. xylosoxidans was cultured from both patients. Clinical resolution occurred with treatment consisting of topical fortified antibiotics. In one patient, the flap was lifted to obtain cultures and irrigate the stromal bed with fortified antibiotics.


CONCLUSIONS
Post-LASIK epithelial ingrowth may have served as a risk factor for A. xylosoxidans infection. Classic signs of infectious keratitis were absent, delaying the diagnosis. Three clinical stages described herein may assist the clinician with diagnosis and customized management obviating the need for penetrating keratoplasty.
Kamran M
KM
Riaz
Robert S
RS
Feder
Arth
A
Srivastava
Jonathan
J
Rosin
Surendra
S
Basti
D042441:Achromobacter denitrificans / Q000302:isolation & purification*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003316:Corneal Diseases / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007634:Keratitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D020731:Keratomileusis, Laser In Situ; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
D000900:Anti-Bacterial Agents; D005938:Glucocorticoids