Achromobacter xylosoxidans Keratitis Masquerading as Recurrent Erosion After LASIK

Abstract

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.

Refractive Errors & Refractive Surgery Preferred Practice Pattern®

“…Epithelial ingrowth may be a risk factor for the development of microbial keratitis. [473][474][475] Scrapings should be obtained from the involved area and submitted for microbiological investigation. If the flap interface is involved but no surface ulceration is observed, the flap should be elevated to allow access for scrapings.…”

Late onset of microbial keratitis after laser in situ keratomileusis surgery: case series

“…25 A defectiva 26 There are several reports of uncommon microorganisms post-LASIK. [27][28][29] It is difficult to assess whether previous LASIK results in a predisposition for rare bacterial infections or whether they were reported due to a positive publication bias and would not have been reported if the affected patient had not undergone LASIK surgery. However, overall, the microbiological profile of keratitis in patients late after LASIK may be similar to that in patients who have not had LASIK.…”

The successful treatment of a multidrug-resistantAchromobacter xylosoxidanscorneal ulcer with topical meropenem

“…Risk factors include contact lens wear,5 history of previous corneal surgery (Laser-assisted  in situ keratomileusis (LASIK)8 9; keratoplasty4) and a compromised ocular surface 5. A proposed mechanism for contact lens keratitis is based on hypoxia leading to elevated levels of lactic acid and relative glycogen deficiency that result in corneal epithelial injury, with loss of barrier function, which may permit the motile A. xylosoxidans bacterium to penetrate the cornea 8. Various treatment regimens have been reported for Achromobacter keratitis, but the organism was typically sensitive to quinolones and ceftazidime 7.…”