Bilateral Mycobacterium abscessus keratitis after laser in situ keratomileusis

A 35-year-old man was diagnosed with Mycobacterium abscessus keratitis in the left eye 3 weeks after bilateral laser in situ keratomileusis (LASIK). Infection in the right eye developed 6 weeks after surgery. Despite aggressive treatment with topical amikacin and clarithromycin and oral clarithromycin, the infection progressed in both eyes. To improve antibiotic penetration, the LASIK flap was removed in both eyes. Culture positivity was prolonged; however, after 8 weeks of intensive topical antibiotics, the infection was eradicated. The final best corrected visual acuity was 20/30 in both eyes.     

Bilateral Candida parapsilosis interface keratitis after laser in situ keratomileusis

We report a case of Candida infection after laser in situ keratomileusis (LASIK) and review the literature for reports of post-LASIK fungal infections. Risk factors may include postoperative surgical intervention and extended use of topical steroids.     

Bilateral infectious keratitis after a laser in situ keratomileusis enhancement procedure

We report a case of bilateral infectious keratitis occurring as a complication of bilateral simultaneous laser in situ keratomileusis enhancement procedures. Corneal scraping from the interface of both eyes grew Staphylococcus aureus. The infection cleared after treatment with fortified cefazolin, fortified gentamicin, and ciprofloxacin eyedrops. The patient was left with bilateral paracentral corneal scars. When bilateral surgery is performed, bilateral infection may occur as a rare complication.     

Fungal keratitis after laser in situ keratomileusis

A 22-year-old woman presented with pain, redness, watering, and decrease in vision in her left eye 15 days after laser in situ keratomileusis for myopia. Slitlamp examination showed a central full-thickness infiltrate with hyphate edges. Microscopic examination of corneal scrapings from the edge and underneath the flap showed fungal filaments, and the growth on culture media was identified as Scedosporium apiospermum.     

Delayed keratitis after laser in situ keratomileusis

We report 2 cases of delayed keratitis that occurred after uneventful laser in situ keratomileusis (LASIK). The first patient presented with a peripheral corneal infiltrate 3 months after a LASIK enhancement procedure. The infiltrate progressed despite treatment with topical combination tobramycin-dexamethasone. The flap was then lifted and the interface was irrigated with fortified antibiotics. The keratitis promptly resolved, and the patient recovered a best corrected visual acuity (BCVA) of 20/20. The second patient presented with decreased vision, inflammation, and a sublamellar infiltrate 1 month after primary LASIK. The flap was promptly lifted and irrigated with antibiotics. Cultures were positive for Staphylococcus epidermidis. One week later, the infiltrate had resolved and BCVA had returned to 20/20. Delayed bacterial keratitis has been described as a rare occurrence after incisional refractive surgery. To the best of our knowledge, it has not yet been reported after LASIK. It is important to consider infectious keratitis in the differential diagnosis of a patient who presents with corneal inflammation, even months after having LASIK.     

Mycobacterium keratitis after laser in situ keratomileusis

PURPOSE: We present a case of Mycobacterium keratitis after laser in situ keratomileusis (LASIK). METHOD: A retrospective case report. RESULTS: A 40-year-old woman developed Mycobacterium chelonae keratitis in the right eye 2 weeks after bilateral LASIK. The diagnosis was made by acid-fast staining of corneal scrapings on admission and confirmed by culture results 2 weeks later. Intensive treatment with topical amikacin (25 mg/mL) and ciprofloxacin and partial excision of the flap led to resolution of the infection after 2 months of therapy. In addition, topical methylprednisolone (1 mg/mL) was necessary to control inflammation and pain. No recurrence was found during the 1-year follow-up period. The final uncorrected and corrected visual acuity in the right eye was 20/25 and 20/20, respectively. CONCLUSION: Mycobacterium keratitis is a potentially vision-threatening complication after LASIK. Early recognition of the organisms and aggressive treatment if infection develops may improve the outcome. When surgery is indicated, partial flap amputation, which may help to resolve the infection and preserve better vision, may be considered.     

Pseudomonas keratitis after laser in situ keratomileusis

We report a 32-year-old woman who presented with infectious keratitis in the right eye 3 weeks after laser in situ keratomileusis (LASIK). On microbiological investigations, the microorganism isolated was Pseudomonas aeruginosa that was sensitive to ciprofloxacin. To our knowledge, this is the only case report in the literature of post-LASIK infectious keratitis caused by P aeruginosa.     

准分子激光角膜屈光术后感染性角膜炎

准分子激光角膜屈光术后感染性角膜炎是准分子激光角膜屈光术后少见而严重的并发症，一旦发生，可对视力造成严重损害。完善的术前筛查及准备工作、术中严格的无菌操作、术后合理用药及定期随访、一旦感染发生能及时正确地处理可有效预防或控制感染，最大限度地减轻并发症对视力的损害。     

Polymicrobial keratitis after laser in situ keratomileusis

PURPOSE: To report a case of polymicrobial infectious keratitis in one eye of a patient who had undergone bilateral simultaneous laser in situ keratomileusis (LASIK). METHODS: A 21-year-old healthy female developed infectious keratitis in her right eye after bilateral LASIK surgery. Material obtained from the infective foci was sent for bacterial and fungal cultures and herpes simplex virus antigen detection, and broad spectrum antimicrobial therapy was instituted. RESULTS: Staphylococcus epidermidis and Fusarium solani were detected on culture and herpes simplex virus antigen was found to be positive. The patient did not respond to medical therapy and subsequently the ulcer perforated. A therapeutic keratoplasty was performed and the final best-corrected visual acuity was 20/40, 1 month after keratoplasty. CONCLUSION: Polymicrobial infectious keratitis, although rare, is a potential sight-threatening complication of LASIK.     

Microbial keratitis after laser in situ keratomileusis

PURPOSE AND METHOD: To review the literature on microbial keratitis reported after laser in situ keratomileusis (LASIK). RESULTS: Forty-one eyes have been reported to have microbial keratitis after LASIK. The causative organisms vary from gram positive bacteria to atypical mycobacteria, fungal, and viral pathogens. The infection is usually acquired intraoperatively, but may also be caused by postoperative contamination. A majority of the patients present within 72 hours of the surgery with an acute onset of symptoms. Management of microbial keratitis after LASIK includes aggressive topical fortified antibiotic therapy, irrigation of stromal bed with antibiotic solution after lifting the flap, and sending the scraping of the infiltrate for microbiological evaluation. The keratitis heals with scarring and a best spectacle-corrected visual acuity of 20/40 or better can be obtained in the majority of the patients. CONCLUSION: Microbial keratitis is a sight-threatening complication of LASIK.     

Mycobacterium keratitis after laser in situ keratomileusis

PURPOSE: The authors report two cases of Mycobacterium keratitis following LASIK. METHODS: The case reports are based on a retrospective review of clinical history and associated findings. RESULTS: Two patients developed infectious keratitis after undergoing laser in situ keratomileusis (LASIK). In case #1, the infection developed after manipulation of the lamellar flap to remove epithelium from the stromal bed. In case #2, prior radial keratotomy may have been a contributing factor to development of the infection. Corneal infiltrates appeared as focal, white, stromal deposits. Cultures isolated Mycobacterium fortuitum from case #1 and Mycobacterium chelonae from case #2. Topical fortified amikacin, clarithromycin, tobramycin, and ciprofloxacin eventually controlled the infection. Topical prednisolone acetate and bandage contact lenses were necessary to control inflammation and pain. Infiltrates were slow to resolve until focal necrosis eroded through the flaps leading to rapid clearing of the infiltrates; however, scarring of the cornea developed at the site of necrosis. Visual recovery was good in the first case but limited in the second. CONCLUSIONS: Mycobacterium keratitis complicating LASIK may be difficult to eradicate until the sequestered stromal infiltrate drains. Rapid recognition of the causative organism and aggressive medical and surgical management of the infection may improve the outcome.     

Pneumococcal keratitis after laser in situ keratomileusis

A 20-year-old man developed keratitis in his right eye 2 days after laser in situ keratomileusis (LASIK). The patient had rubbed the eye with unclean fingers the night before the onset of symptoms. Examination showed an inferior corneal ulcer with dense infiltration at the junction of the lamellar flap and the surrounding cornea associated with a hypopyon. Streptococcus pneumoniae was isolated on culture. The ulcer resolved with combination therapy of cephazolin 5% and tobramycin 1.3% eyedrops. Patients having LASIK should be instructed that inadequate patient hygiene may predispose to bacterial keratitis.     

Bilateral marginal sterile infiltrates and diffuse lamellar keratitis after laser in situ keratomileusis

PURPOSE: To report cases of acute bilateral catarrhal infiltrates in the early postoperative period after laser in situ keratomileusis (LASIK). METHODS: Retrospective review of both eyes of two patients. RESULTS: Two patients developed acute bilateral, marginal, catarrhal infiltrates in the early postoperative period after LASIK. Both patients had moderate to severe chronic meibomian gland dysfunction preoperatively. One patient (both eyes) developed grade 3 diffuse lamellar keratitis (DLK) that required both flaps to be lifted for irrigation and cleaning on postoperative day 5. Fungal and bacterial cultures were negative in both eyes of both patients. The condition resolved with intensive topical corticosteroids and fortified antibiotics. Regression of refractive error and the need for enhancement was encountered in all eyes. There was mild recurrence in one eye of each patient with pretreatment with topical corticosteroids prior to enhancement. CONCLUSIONS: Endogenous factors such as chronic blepharitis and meibomian gland dysfunction may trigger inflammation resulting in sporadic cases of catarrhal infiltrates after LASIK. These patients may have chronic inflammatory milieus that can trigger sporadic cases of catarrhal infiltrates after LASIK, with accompanying diffuse lamellar keratitis.     

Streptococcal keratitis after myopic laser in situ keratomileusis

A 24-year-old healthy male underwent uncomplicated laser in situ keratomileusis (LASIK) in left eye. One day after the surgery, he complained of ocular pain and multiple corneal stromal infiltrates had developed in left eye. Immediately, the corneal interface and stromal bed were cleared, and maximal antibiotic treatments with fortified tobramycin (1.2%) and cefazolin (5%) were given topically. The causative organism was identified as 'Streptococcus viridans' both on smear and culture. Two days after antibiotic therapy was initiated, the ocular inflammation and corneal infiltrates had regressed and ocular pain was relieved. One month later, the patient's best corrected visual acuity had returned to 20/20 with -0.75 -1.00 x 10 degrees, however minimal stromal scarring still remained. This case demonstrates that microbial keratitis after LASIK, if treated promptly, does not lead to a permanent reduction in visual acuity.     

Aspergillus flavus keratitis after laser in situ keratomileusis

PURPOSE: To report a case of fungal keratitis caused by Aspergillus flavus after laser in situ keratomileusis surgery. METHODS: Case report. A 24-year-old woman developed pain, redness, decreased vision, and an infiltrate posterior to the corneal flap in her right eye 3 days after laser in situ keratomileusis. On referral, approximately 3 weeks after laser in situ keratomileusis, examination of the right eye revealed light perception vision, a large full-thickness corneal infiltrate, and hypopyon. Corneal scrapings were taken for direct microscopic examination and culture. RESULTS: Corneal scraping revealed the presence of fungal filaments in smears and in culture. The fungus was identified as A. flavus. Intensive topical natamycin and systemic ketoconazole therapy was initiated. Despite intensive medical treatment, the infiltrate progressed and the patient was subjected to a therapeutic penetrating keratoplasty. There was no recurrence of infection after surgery. At last follow-up 4 months after surgery, the eye was quiet with graft edema. CONCLUSION: Fungal keratitis is a rare complication of laser in situ keratomileusis surgery. In a case that does not respond to medical treatment, early surgical intervention must be considered.     

Exophiala dermatitidis keratitis after laser in situ keratomileusis

A 52-year-old man had laser in situ keratomileusis in March 2002 and 2 weeks later had a corneal infection that was found to be caused by Exophiala dermatitidis. This infection waxed and waned for 9 months despite therapy with natamycin, itraconazole, and fluconazole but eventually responded to topical amphotericin. He recovered good visual acuity in this eye with a rigid gas-permeable lens. This case shows the importance of selecting the appropriate agent in fungal keratitis.     

Rhodococcus globerulus keratitis after laser in situ keratomileusis

A healthy 20-year-old woman with myopia had uneventful bilateral laser in situ keratomileusis after which the uncorrected visual acuity was 20/20 in the right eye and 20/30 in the left eye. Fifteen days later, a stromal paraxial lesion was found in the right eye with a corresponding loss of visual acuity, pain, and photophobia. The flap was lifted and the infiltrate scraped for smears. Cultures showed that Rhodococcus globerulus was the infectious agent. Intensive topical antibiotic treatment was applied with good visual results.