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Delayed onset Mycobacterium intracellulare keratitis after laser in situ keratomileusis: A case report and literature review

 JaeSang Ko  ;  Se Kyung Kim  ;  Dong Eun Yong  ;  Tae-im Kim  ;  Eung Kweon Kim 
 Medicine, Vol.96(51) : e9356, 2017 
Journal Title
Issue Date
Administration, Topical ; Adult ; Amikacin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Clarithromycin/therapeutic use ; Drug Therapy, Combination ; Eye Infections, Bacterial/diagnosis ; Eye Infections, Bacterial/drug therapy ; Eye Infections, Bacterial/etiology ; Fluoroquinolones/therapeutic use ; Follow-Up Studies ; Humans ; Keratitis/drug therapy ; Keratitis/etiology ; Keratitis/microbiology ; Keratomileusis, Laser In Situ/adverse effects ; Keratomileusis, Laser In Situ/methods ; Male ; Mycobacterium avium Complex/isolation & purification ; Severity of Illness Index ; Treatment Outcome
RATIONALE: Infectious keratitis is a relatively uncommon but potentially sight-threatening complication of laser in situ keratomileusis (LASIK). Mycobacterial keratitis is usually regarded as late onset keratitis among post-LASIK keratitis. There has been no documented case of Mycobacterium intracellulare post-LASIK keratitis of a long-latent period. PATIENT CONCERNS: A 36-year-old man was referred to our out-patient clinic, for persistent corneal epithelial defect with intrastromal infiltration. He had undergone uneventful bilateral LASIK procedure 4 years before. He complained decreased vision, accompanied by ocular pain, photophobia, and redness in his left eye for 7 months. DIAGNOSIS: Lamellar keratectomy was taken using femtosecond laser. Bacterial culture with sequenced bacterial 16s ribosomal DNA confirmed the organism to be M intracellulare. INTERVENTIONS: After 3 months of administration of topical clarithromycin, amikacin, and moxifloxacin, the corneal epithelial defect was resolved and the infiltration was much improved. However, newly developed diffuse haziness with surrounding granular infiltration in the central cornea was noted. Drug toxicity was suspected and topical moxifloxacin was discontinued, resulting in resolution of the diffuse haze with infiltration. OUTCOME: The patient was followed up regularly without medication thereafter and recurrence was not found for 7 years. LESSONS: This case presents the first case of M intracellulare keratitis after LASIK. LASIK surgeons should aware that post-LASIK keratitis can develop long after the operation and careful suspicion of infectious disease with meticulous diagnostic test is needed.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Ophthalmology (안과학교실)
Yonsei Authors
고재상(Ko, Jaesang) ORCID logo https://orcid.org/0000-0002-3011-7213
김응권(Kim, Eung Kweon)
김태임(Kim, Tae Im) ORCID logo https://orcid.org/0000-0001-6414-3842
용동은(Yong, Dong Eun) ORCID logo https://orcid.org/0000-0002-1225-8477
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