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Recalcitrant post-LASIK Mycobacterium chelonae keratitis eradicated after the use of fourth-generation fluoroquinolone.
Ophthalmology. 2006 Jun; 113(6):950-4.O

Abstract

OBJECTIVE

To report a patient with Mycobacterium chelonae keratitis after LASIK and discuss therapeutic measures.

DESIGN

Interventional case report and literature review.

INTERVENTION

A healthy, 25-year-old man presented 6 weeks after LASIK with infectious keratitis in the left eye. Scrapings were obtained from the central stromal bed after lifting the flap and inoculated on culture media.

MAIN OUTCOME MEASURES

Response to medical treatment.

RESULTS

Mycobacterium chelonae was identified from stromal bed scrapings. The protracted course of the infection necessitated surgical debridement and flap amputation with slow and suboptimal response to prolonged (14 weeks) treatment with topical amikacin 3.3%, clarithromycin 1%, and levofloxacin 0.5%. The substitution of levofloxacin 0.5% with gatifloxacin 0.3% resulted in closure of the epithelial defect within 1 week and resolution of the infiltrates in 3 weeks. The combined regimen of gatifloxacin 0.3%, amikacin 3.3%, and clarithromycin 1% was continued for a total of 4 months. The patient remains infection free 1 year after stopping all antibiotics.

CONCLUSION

Treatment of post-LASIK nontuberculous mycobacteria remains a challenge. Institution of combination therapy including fortified amikacin, clarithromycin 1%, and a fourth-generation fluoroquinolone appeared to be beneficial in this patient.

Authors+Show Affiliations

Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

16647126

Citation

Hamam, Rola N., et al. "Recalcitrant post-LASIK Mycobacterium Chelonae Keratitis Eradicated After the Use of Fourth-generation Fluoroquinolone." Ophthalmology, vol. 113, no. 6, 2006, pp. 950-4.
Hamam RN, Noureddin B, Salti HI, et al. Recalcitrant post-LASIK Mycobacterium chelonae keratitis eradicated after the use of fourth-generation fluoroquinolone. Ophthalmology. 2006;113(6):950-4.
Hamam, R. N., Noureddin, B., Salti, H. I., Haddad, R., & Khoury, J. M. (2006). Recalcitrant post-LASIK Mycobacterium chelonae keratitis eradicated after the use of fourth-generation fluoroquinolone. Ophthalmology, 113(6), 950-4.
Hamam RN, et al. Recalcitrant post-LASIK Mycobacterium Chelonae Keratitis Eradicated After the Use of Fourth-generation Fluoroquinolone. Ophthalmology. 2006;113(6):950-4. PubMed PMID: 16647126.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recalcitrant post-LASIK Mycobacterium chelonae keratitis eradicated after the use of fourth-generation fluoroquinolone. AU - Hamam,Rola N, AU - Noureddin,Baha, AU - Salti,Haytham I, AU - Haddad,Randa, AU - Khoury,Johnny M, Y1 - 2006/04/27/ PY - 2005/06/05/received PY - 2006/02/15/revised PY - 2006/02/15/accepted PY - 2006/5/2/pubmed PY - 2006/6/14/medline PY - 2006/5/2/entrez SP - 950 EP - 4 JF - Ophthalmology JO - Ophthalmology VL - 113 IS - 6 N2 - OBJECTIVE: To report a patient with Mycobacterium chelonae keratitis after LASIK and discuss therapeutic measures. DESIGN: Interventional case report and literature review. INTERVENTION: A healthy, 25-year-old man presented 6 weeks after LASIK with infectious keratitis in the left eye. Scrapings were obtained from the central stromal bed after lifting the flap and inoculated on culture media. MAIN OUTCOME MEASURES: Response to medical treatment. RESULTS: Mycobacterium chelonae was identified from stromal bed scrapings. The protracted course of the infection necessitated surgical debridement and flap amputation with slow and suboptimal response to prolonged (14 weeks) treatment with topical amikacin 3.3%, clarithromycin 1%, and levofloxacin 0.5%. The substitution of levofloxacin 0.5% with gatifloxacin 0.3% resulted in closure of the epithelial defect within 1 week and resolution of the infiltrates in 3 weeks. The combined regimen of gatifloxacin 0.3%, amikacin 3.3%, and clarithromycin 1% was continued for a total of 4 months. The patient remains infection free 1 year after stopping all antibiotics. CONCLUSION: Treatment of post-LASIK nontuberculous mycobacteria remains a challenge. Institution of combination therapy including fortified amikacin, clarithromycin 1%, and a fourth-generation fluoroquinolone appeared to be beneficial in this patient. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/16647126/Recalcitrant_post_LASIK_Mycobacterium_chelonae_keratitis_eradicated_after_the_use_of_fourth_generation_fluoroquinolone_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(06)00288-0 DB - PRIME DP - Unbound Medicine ER -