Bilateral infectious keratitis after laser in situ keratomileusis - A casereport and review of the literature

Objective: To report a case of bilateral infectious keratitis after simulta neous bilateral laser in situ keratomileusis (LASIK) and to explore appropr iate preventive, diagnostic, and therapeutic measures. Design: Interventional case report and literature review. Intervention: A 22-year-old woman had bilateral corneal infiltrates after s imultaneous bilateral LASIK. The same set of instruments was used for surge ry on both eyes. Corneal scrapings from the edge of the infiltrate and unde rneath the flap were taken for microscopic examination and inoculation on c ulture media. Treatment consisted of irrigation of stromal bed with amikaci n sulphate (2.5%) solution along with half hourly instillation of amikacin (2.5%) and cefazolin (5%) eye drops. Main Outcome Measures: Causative organism and response to medical treatment . Results: Culture revealed a significant growth of Mycobacterium chelonae fr om the corneal scrapings of both eyes. There was progressive thinning of co rneal stroma in the right eye requiring cyanoacrylate tissue adhesive appli cation. The left eye showed progressive worsening after initial response an d required penetrating keratoplasty. Conclusions: The risk of bilateral sight-threatening complications must be kept in mind when contemplating bilateral simultaneous LASIK. Nontuberculou s mycobacteria should be considered as an etiologic agent in cases of infec tious keratitis occurring after LASIK. Microbiology work-up of a specimen c ollected directly from the site of lesion can help in early diagnosis and i nstitution of appropriate therapy. Ophthalmology 2001;108:121-125 (C) 2001 by the American Academy of Ophthalmology.