title: Recurrent non-tuberculous mycobacterial keratitis after deep anterior lamellar keratoplasty for keratoconus.
abstract: A 26-year-old farmer underwent deep anterior lamellar keratoplasty (DALK) for keratoconus. After 3 months, he presented with interface keratitis. Medical treatment failed and he underwent a repeat DALK. Microbiological scrapings from the interface revealed an infection caused by non-tuberculous mycobacteria. Despite the use of intensive antibiotic therapy and a repeat lamellar keratoplasty, the infiltrates recurred. The patient underwent therapeutic penetrating keratoplasty. Microbiology of the corneal tissue revealed growth of Mycobacterium chelonae, and on histopathology, the acid-fast bacilli were noted to be located deep at the pre-Descemet level. There was complete resolution of the infection with no episodes of recurrence and final best-corrected visual acuity was 20/40 at 1 year of follow-up. Medical therapy is unlikely to succeed in post-DALK interface keratitis and penetrating rather than lamellar keratoplasty may be considered the surgery of choice.
authors.affiliation: Cornea and Anterior Segment Service, LV Prasad Eye Institute, Hyderabad, Andrapradesh, India.
authors.forename: Somasheila I
authors.initials: SI
authors.lastname: Murthy
authors.forename: Rajat
authors.initials: R
authors.lastname: Jain
authors.forename: Rishi
authors.initials: R
authors.lastname: Swarup
authors.forename: Virender S
authors.initials: VS
authors.lastname: Sangwan
mesh_terms: D000328:Adult; D003315:Cornea / Q000473:pathology; D016039:Corneal Transplantation / Q000009:adverse effects*; D006801:Humans; D007634:Keratitis / Q000209:etiology* / Q000382:microbiology / Q000473:pathology; D007640:Keratoconus / Q000601:surgery*; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000209:etiology* / Q000382:microbiology / Q000473:pathology