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 h istory 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 t o development of the infection. Corneal infiltrates appeared as focal, whit e, stromal deposits. Cultures isolated Mycobacterium fortuitum from case #1 and Mycobacterium chelonae from case #2. Topical fortified amikacin, clari thromycin, tobramycin, and ciprofloxacin eventually controlled the infectio n. Topical prednisolone acetate and bandage contact lenses were necessary t o control inflammation and pain. Infiltrates were slow to resolve until foc al necrosis eroded through the flaps leading to rapid clearing of the infil trates; however, scarring of the cornea developed at the site of necrosis. Visual recovery was good in the first case but limited ill the second. CONCLUSIONS: Mycobacterium keratitis complicating LASIK may be difficult to eradicate until the sequestered stromal infiltrate drains. Rapid recogniti on of the causative organism and aggressive medical and surgical management of the infection may improve the outcome.