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A cluster of Nocardia keratitis after LASIK
Prashant Garg1, Savitri Sharma, Geeta K Vemuganti
1Cornea and Anterior Segment Service, L V Prasad Eye Institute, Hyderabad, India. prashant@lvpei.org
Purpose:
To report a cluster of Nocardia asteroides keratitis cases after LASIK.
Methods:
Retrospective review of the history and examination of three patients (four eyes) operated on the same day at a single center who developed postoperative keratitis. All patients underwent lifting of the superficial flap for microbiologic evaluation of the corneal scrapings. The operating surgeon was contacted to identify the possible source of contamination.
Results:
Two patients underwent simultaneous bilateral LASIK; however, only one developed postoperative keratitis in both eyes. One patient had unilateral surgery and developed keratitis in the operated eye. Microscopic examination of smears from all eyes revealed thin, branching, acid-fast, filamentous bacteria that were identified as Nocardia asteroides after culture. The infiltrates resolved with topical administration of amikacin sulphate (2.5%) and topical and oral trimethoprim-sulfamethoxazole. Final visual acuity ranged between 20/25 and 20/80. The operating surgeon had used the same blade and microkeratome in all patients.
Conclusions:
Nocardia, a relatively unusual organism, can cause an epidemic of infection after LASIK.
Insights
A cluster of Nocardia asteroides keratitis infections occurred after LASIK surgery. Prompt treatment with antibiotics resolved the infections, highlighting the importance of identifying contamination sources in refractive surgery.
Area of Science:
- Ophthalmology
- Microbiology
- Infectious Diseases
Background:
- Laser-assisted in situ keratomileusis (LASIK) is a common refractive surgery.
- Postoperative keratitis can lead to vision impairment.
- Nocardia asteroides is an uncommon cause of ocular infections.
Purpose of the Study:
- To report a cluster of Nocardia asteroides keratitis cases following LASIK.
- To identify the potential source of infection in these cases.
Main Methods:
- Retrospective review of three patients (four eyes) who developed keratitis after LASIK.
- Microbiologic evaluation of corneal scrapings.
- Investigation of the surgical procedure and instruments for contamination.
Main Results:
- Nocardia asteroides was identified in all affected eyes.
- A common surgical blade and microkeratome were used for all patients.
- Infections resolved with amikacin sulphate and trimethoprim-sulfamethoxazole.
Conclusions:
- Nocardia asteroides can cause epidemic keratitis after LASIK.
- Identifying and controlling contamination sources is crucial in refractive surgery.
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