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Mixed Acanthamoeba and multidrug-resistant Achromobacter xyloxidans in late-onset keratitis after laser in situ keratomileusis.
J Cataract Refract Surg. 2012 Oct; 38(10):1853-6.JC

Abstract

A 31-year-old woman developed a spontaneous flap interface keratitis in the left eye 6 years after a laser in situ keratomileusis (LASIK) enhancement. Cultures and polymerase chain reaction (PCR) were positive for Achromobacter xyloxidans resistant to first- and second-generation cephalosporin, aminoglycosides, and quinolones and also positive for Acanthamoeba T4. Treatment with topical fortified ceftazidime, topical chlorhexidine, and voriconazole and oral voriconazole did not stop the progression of the disease. Flap amputation revealed persistence of Acanthamoeba but not Achromobacter. Six weeks after flap amputation, the infiltrate had resolved, PCR was negative for Acanthamoeba, and the cornea had fully epithelialized. To our knowledge, this is the first report of post-LASIK infectious keratitis caused by mixed infection of Achromobacter xyloxidans and Acanthamoeba occurring years after the procedure without apparent ocular trauma. It is also the first report of the use of combined systemic and topical voriconazole as a therapy for Acanthamoeba keratitis after LASIK.

Authors+Show Affiliations

Cornea Unit, Ophthalmology Department, Ramón y Cajal University Hospital, Madrid, Spain. farnalich@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22999604

Citation

Arnalich-Montiel, Francisco, et al. "Mixed Acanthamoeba and Multidrug-resistant Achromobacter Xyloxidans in Late-onset Keratitis After Laser in Situ Keratomileusis." Journal of Cataract and Refractive Surgery, vol. 38, no. 10, 2012, pp. 1853-6.
Arnalich-Montiel F, Almendral A, Arnalich F, et al. Mixed Acanthamoeba and multidrug-resistant Achromobacter xyloxidans in late-onset keratitis after laser in situ keratomileusis. J Cataract Refract Surg. 2012;38(10):1853-6.
Arnalich-Montiel, F., Almendral, A., Arnalich, F., Valladares, B., & Lorenzo-Morales, J. (2012). Mixed Acanthamoeba and multidrug-resistant Achromobacter xyloxidans in late-onset keratitis after laser in situ keratomileusis. Journal of Cataract and Refractive Surgery, 38(10), 1853-6. https://doi.org/10.1016/j.jcrs.2012.08.022
Arnalich-Montiel F, et al. Mixed Acanthamoeba and Multidrug-resistant Achromobacter Xyloxidans in Late-onset Keratitis After Laser in Situ Keratomileusis. J Cataract Refract Surg. 2012;38(10):1853-6. PubMed PMID: 22999604.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mixed Acanthamoeba and multidrug-resistant Achromobacter xyloxidans in late-onset keratitis after laser in situ keratomileusis. AU - Arnalich-Montiel,Francisco, AU - Almendral,Alfonso, AU - Arnalich,Francisco, AU - Valladares,Basilio, AU - Lorenzo-Morales,Jacob, PY - 2012/02/27/received PY - 2012/03/19/revised PY - 2012/03/20/accepted PY - 2012/9/25/entrez PY - 2012/9/25/pubmed PY - 2013/1/10/medline SP - 1853 EP - 6 JF - Journal of cataract and refractive surgery JO - J Cataract Refract Surg VL - 38 IS - 10 N2 - A 31-year-old woman developed a spontaneous flap interface keratitis in the left eye 6 years after a laser in situ keratomileusis (LASIK) enhancement. Cultures and polymerase chain reaction (PCR) were positive for Achromobacter xyloxidans resistant to first- and second-generation cephalosporin, aminoglycosides, and quinolones and also positive for Acanthamoeba T4. Treatment with topical fortified ceftazidime, topical chlorhexidine, and voriconazole and oral voriconazole did not stop the progression of the disease. Flap amputation revealed persistence of Acanthamoeba but not Achromobacter. Six weeks after flap amputation, the infiltrate had resolved, PCR was negative for Acanthamoeba, and the cornea had fully epithelialized. To our knowledge, this is the first report of post-LASIK infectious keratitis caused by mixed infection of Achromobacter xyloxidans and Acanthamoeba occurring years after the procedure without apparent ocular trauma. It is also the first report of the use of combined systemic and topical voriconazole as a therapy for Acanthamoeba keratitis after LASIK. SN - 1873-4502 UR - https://www.unboundmedicine.com/medline/citation/22999604/Mixed_Acanthamoeba_and_multidrug_resistant_Achromobacter_xyloxidans_in_late_onset_keratitis_after_laser_in_situ_keratomileusis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0886-3350(12)01182-0 DB - PRIME DP - Unbound Medicine ER -