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Delayed-onset mycobacterial keratitis after LASIK.
Samuel F A Fulcher1, Robert C Fader, Robert H Rosa
1Division of Ophthalmology, Scott & White Memorial Hospital and Clinic, 2401 South 31st Street, Temple, TX 76508, USA. sfulcher@mailbox.sw.org
Cornea
|July 20, 2002
Summary
Nontuberculous mycobacterial keratitis, specifically Mycobacterium szulgai, can occur after laser in situ keratomileusis (LASIK). Prompt diagnosis and susceptibility-guided treatment, including clarithromycin, are crucial for preserving visual outcomes.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Laser in situ keratomileusis (LASIK) is a common refractive surgery procedure.
- Post-LASIK keratitis, particularly from nontuberculous mycobacteria, presents a diagnostic challenge.
- Mycobacterium szulgai is an uncommon but significant cause of infectious keratitis.
Observation:
- Seven cases of Mycobacterium szulgai keratitis occurred 7 to 24 weeks post-LASIK.
- Infection was linked to contaminated ice used for saline lavage during the procedure.
- Clinical presentation varied, with delayed onset after LASIK.
Findings:
- Cultures identified Mycobacterium szulgai in five patients.
- Empiric therapy was often unsatisfactory; susceptibility-guided treatment, including clarithromycin, led to resolution.
- Most patients achieved good visual recovery, with one experiencing a minor loss of visual acuity.
Implications:
- Nontuberculous mycobacterial keratitis post-LASIK requires careful diagnosis and tailored treatment based on antimicrobial susceptibility.
- Strict adherence to sterile protocols during LASIK surgery is paramount to prevent such infections.
- This study highlights the importance of identifying the source of contamination to prevent outbreaks.