Nontuberculous mycobacterial keratitis after photorefractive keratectomy for myopia
Abstract number: p1136
Mylona-Petropoulou D., Vrioni G., Ganteris G., Miltsakakis D., Kyratsa A., Mougnai C., Kouris A., Levidiotou S., Malamou-Lada H.
To report a case of nontuberculous mycobacterial keratitis after photorefractive keratectomy for myopia.
A 45-year-old woman in good health developed increased conjunctival redness, swelling and marked decrease of vision in the right eye, 6 weeks after unilateral photorefractive keratectomy for myopia. Initial treatment included topical steroids, ofloxacin ophthalmic drops, and systemic treatment with fluconazole and vibramycin. After 4 more weeks without improvement, the patient was referred to our hospital. A diagnosis of infectious keratitis with corneal ulcer in the right eye was made. Corneal scrapings were sent for culture and microscopic examination, and therapy with vancomycin and tobramycin was initiated.
Acid-fast bacteria were seen on smears. Cultures on Lowenstein-Jensen medium grew Mycobacterium chelonae complex (group III, M. abscessus) that was identified using two different reverse hybridization line probe assays: GenoType Mycobacteria CM (Hain Lifescience, Germany) and INNO-LiPA Mycobacteria v2 (Innogenetics, Belgium). Susceptibility testing was performed by E test method (Solna, Sweden) and the isolate was susceptible to amikacin and clarithromycin. Based on microbiological results, topical therapy using amikacin was initiated. After 5 weeks of treatment due to no-improvement, topical imipenem was added to her treatment regimen. All medications were discontinued 4 weeks later and final visual acuity was 7/10.
This case emphasizes the possibility of nontuberculous mycobacterial keratitis as a potential sight-threatening complication after photorefractive keratectomy for myopia and the possible difficulties in treating such infection. Early and accurate diagnosis can lead to prompt management of the infection with immediate and aggressive antibiotic therapy.
|Session name:||XXIst ISTH Congress|
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