Mycobacterium chelonae keratitis after laser in situ keratomileusis successfully treated with medical therapy and flap removal

PURPOSE: To report a case of Mycobacterium chelonae keratitis after laser i n situ keratomileusis successfully treated with medical therapy and flap re moval. METHODS: Case report. A 36-year-old white woman in good health developed a paracentral keratitis in her right eye 1 month after bilateral laser in sit u keratomileusis. Initial treatment included topical steroids and then inte nsive Ocuflox (ofloxacin ophthalmic solution; Allergan, Inc, Irvine, Califo rnia) without success. Cultures were negative. The keratitis worsened, and she was referred to our institution. Interface infiltration was noted, and the flap was lifted to obtain adequate laboratory studies. Cultures were po sitive for M chelonae. RESULTS: The keratitis was treated with intensive topical amikacin sulfate 1%, topical clarithromycin 1%, and Ciloxan (ciprofloxacin HCL; Alcon Labora tories, Inc, Fort Worth, Texas) with minimal improvement in her clinical co ndition. She developed a toxic reaction to amikacin 1%. In order to improve antibiotic penetration, the hazy, ulcerated corneal flap was removed, The keratitis then resolved with intensive topical clarithromycin 1% and Ocuflo x over 5 weeks. The patient now has visual acuity without correction of 20/ 50, despite superficial corneal haze. CONCLUSION: M chelonae is a rare and insidious cause of infection after las er in situ keratomileusis. Diagnosis can be difficult and is often delayed. Aggressive medical management, with flap removal, if needed, may lead to r esolution of infection. (C) 2000 by Elsevier Science Inc. All rights reserv ed.