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Recalcitrant post-LASIK Mycobacterium chelonae keratitis eradicated after the use of fourth-generation
Rola N Hamam1, Baha Noureddin, Haytham I Salti
1Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon.
Objective:
To report a patient with Mycobacterium chelonae keratitis after LASIK and discuss therapeutic measures.
Design:
Interventional case report and literature review.
Intervention:
A healthy, 25-year-old man presented 6 weeks after LASIK with infectious keratitis in the left eye. Scrapings were obtained from the central stromal bed after lifting the flap and inoculated on culture media.
Main Outcome Measures:
Response to medical treatment.
Results:
Mycobacterium chelonae was identified from stromal bed scrapings. The protracted course of the infection necessitated surgical debridement and flap amputation with slow and suboptimal response to prolonged (14 weeks) treatment with topical amikacin 3.3%, clarithromycin 1%, and levofloxacin 0.5%. The substitution of levofloxacin 0.5% with gatifloxacin 0.3% resulted in closure of the epithelial defect within 1 week and resolution of the infiltrates in 3 weeks. The combined regimen of gatifloxacin 0.3%, amikacin 3.3%, and clarithromycin 1% was continued for a total of 4 months. The patient remains infection free 1 year after stopping all antibiotics.
Conclusion:
Treatment of post-LASIK nontuberculous mycobacteria remains a challenge. Institution of combination therapy including fortified amikacin, clarithromycin 1%, and a fourth-generation fluoroquinolone appeared to be beneficial in this patient.
