Nontuberculous (Atypical) Mycobacterial Keratitis After LASIK

John, Thomas; Velotta, Emily

doi:10.1097/01.ico.0000151565.63107.64

Cited by 62 publications

(68 citation statements)

References 120 publications

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“…Although infectious keratitis is a rare complication of LASIK, RGM are the most frequent bacterial agents isolated in such cases (13). This is the third reported outbreak of keratitis caused by RGM following LASIK in Brazil (5, 10), adding to the growing list of 25 cases and outbreaks of these infections which have been published and indexed in PubMed since the first description in 1998 (19).…”

Section: Discussionmentioning

confidence: 99%

An Outbreak of Keratitis Caused by Mycobacterium immunogenum

et al. 2006

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From 8 October to 12 November 2003, 36 patients underwent surgical correction of myopia in a São Paulo, Brazil, clinic. Five patients had clinical signs of infectious keratitis, and a Mycobacterium species with previously unreported patterns determined by PCR restriction enzyme analysis of the hsp65 gene and PCR restriction enzyme analysis of the 16S-23S rRNA internal transcribed spacer (ITS) was isolated from corneal scrapings from four of these patients. Subsequent evaluation by phenotypic tests and partial sequencing of the hsp65, sodA, rpoB, and 16S rRNA genes and the ITS supported the species identification as a variant of Mycobacterium immunogenum. The source of infection was not determined. The outbreak was caused by a single clone, as evidenced by identical pulsed-field gel electrophoresis and enterobacterial repetitive intergenic consensus-PCR profiles. This is the first report of an outbreak where this species was isolated from infected tissues.Species belonging to the Mycobacterium chelonae-abscessus group have been isolated from many environmental sources, including potable water and distribution systems, swimming pool water, metalworking fluids, and soil (9,28,30). Their ability to survive starvation, the resistance to free chlorine or glutaraldehyde observed in some strains, and their ubiquity in the environment create favorable conditions for the occurrence of infections when sterility precautions or disinfection procedures are disregarded (29, 30). Many health care-associated outbreaks caused by M. abscessus or M. chelonae have been documented since the first report in 1969 (12). "Mycobacterium massiliense" and "Mycobacterium bolletii" have been recently described and proposed as M. chelonae-M. abscessus group members, but to date there are no reports concerning their isolation from environmental samples (1, 4). Mycobacterium immunogenum is a recently described rapidly growing species of the M. chelonae-M. abscessus group and occupies the same ecological niche as other M. chelonae-M. abscessus group members. Clinical isolates include those causing disseminated cutaneous infections, catheter-related infections, septic arthritis, chronic pneumonia, pacemaker-related sepsis, and possible keratitis (17, 31). A single genotype was isolated from metalworking fluids at 10 different sites in six states in the United States, where hypersensitivity pneumonitis occurred among metal-grinding machinists, but M. immunogenum was not isolated from those patients (28). This species caused pseudooutbreaks related to bronchoalveolar lavage procedures in Missouri and Maryland, but to date no reports of outbreaks of infections caused by this species have emerged (31). From 8 October to 12 November 2003, 36 patients-71 eyes-had laser in situ keratomileusis (LASIK) performed in a private clinic located in the urban area of the city of São Paulo, Brazil. Among those patients, five had clinical signs of infectious keratitis, and a Mycobacterium species with a distinct PRA-hsp65 (PCR restriction enzyme analysis of the hsp...

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Section: Discussionmentioning

confidence: 99%

An Outbreak of Keratitis Caused by Mycobacterium immunogenum

et al. 2006

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“…According to the literature, atypical mycobacteria is the most common organism causing post-LASIK keratitis and 10% of infectious keratitis cases eventually require penetrating keratoplasty (PKP) because of poor response to medical management. 11,12 Treatment of intractable post-LASIK keratitis due to atypical mycobacteria with CXL has been reported, but all patients ultimately required PKP. 6 We report a case of severe intractable post-LASIK keratitis with corneal melt due to microbiologically proven atypical mycobacteria that was treated simultaneously with combined flap amputation, phototherapeutic keratectomy (PTK), and CXL, which resulted in a favorable visual outcome without further surgical intervention.…”

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confidence: 99%

Combined treatment with flap amputation, phototherapeutic keratectomy, and collagen crosslinking in severe intractable post-LASIK atypical mycobacterial infection with corneal melt

Kymionis

Kankariya

Kontadakis

2012

Journal of Cataract and Refractive Surgery

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A 23-year-old woman was referred for management of intractable post-laser in situ keratomileusis (LASIK) keratitis due to atypical mycobacteria in the left eye. Corrected distance visual acuity was 20/20 in the right eye and counting fingers at 3 meters in the left eye. Slitlamp examination revealed multiple infiltrates in the flap interface and severe corneal stromal melting with thinning. Despite maximum antibiotic therapy for 7 days, the keratitis continued to worsen. A penetrating keratoplasty (PKP) was scheduled. While waiting for a corneal graft, corneal collagen crosslinking (CXL) with riboflavin and ultraviolet-A was proposed as an alternative treatment. Flap amputation and limited phototherapeutic keratotomy (PTK) (10 μm) were also performed. One week postoperatively, all infiltrates and stromal edema had resolved. At 3 months, the uncorrected distance visual acuity improved to 20/35. Corneal crosslinking after flap amputation and limited PTK was an effective treatment for severe intractable post-LASIK keratitis with corneal melting and obviated PKP.

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“…At that time, the cornea was clear except a few small, stationary white opacities, and the eye was white. We applied specific therapy 9 (topical amikacin, systemic clarithromycin, topical moxifloxacin 0.5%) for 2 months. Because we did not see any additional effect, we reduced this therapy stepwise.…”

Section: Casementioning

confidence: 99%

Ultraviolet A/Riboflavin Corneal Cross-linking for Infectious Keratitis Associated With Corneal Melts

Iseli¹,

Thiel²,

Hafezi³

et al. 2008

Cornea

287

204

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Purpose: To evaluate the efficacy of ultraviolet-corneal crosslinking (CXL) for treating infectious melting keratitis.Methods: Five patients with infectious keratitis associated with corneal melting were treated with CXL at the outpatient departments of the Institut für Refraktive und Ophthalmo-Chirurgie and the eye hospital at the University of Zurich. CXL was performed when the infection did not respond to systemic and topical antibiotic therapy. Follow-up after cross-linking ranged from 1 to 9 months.Results: In all cases, the progression of corneal melting was halted after CXL treatment. Emergency keratoplasty was not necessary in any of the 5 cases presented.Conclusions: CXL is a promising option for treating patients with therapy-refractory infectious keratitis to avoid emergency keratoplasty.

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Nontuberculous (Atypical) Mycobacterial Keratitis After LASIK

Abstract: This article provides a comprehensive compilation of all reported cases of nontuberculous (atypical) mycobacterial keratitis in the English literature and provides some useful recommendations for the clinical management of such corneal infection after LASIK.

Cited by 62 publications

References 120 publications

An Outbreak of Keratitis Caused by Mycobacterium immunogenum

An Outbreak of Keratitis Caused by Mycobacterium immunogenum

Combined treatment with flap amputation, phototherapeutic keratectomy, and collagen crosslinking in severe intractable post-LASIK atypical mycobacterial infection with corneal melt

Ultraviolet A/Riboflavin Corneal Cross-linking for Infectious Keratitis Associated With Corneal Melts

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