An outbreak of Mycobacterium chelonae infection after LASIK

Denise Freitas, Lênio Alvarenga, Jorge Sampaio, Mark J Mannis, Elcio Sato, Luciene Sousa, Luiz Vieira, Maria C. Yu, Maria C. Martins, Ana Hoffling-Lima, Rubens Belfort

Research output: Contribution to journalArticle

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Abstract

Objective: To describe an outbreak of mycobacterial keratitis after laser in situ keratomileusis (LASIK), including the microbiologic investigation, clinical findings, treatment response, and outcome. Design: Retrospective, noncomparative, interventional case series. Participants: Patients (n = 10) who underwent LASIK surgery between August 22 and September 4, 2000, and developed mycobacterial infection. Methods: Patients were prospectively followed in relation to microbiologic investigation, clinical findings, treatment response, and outcome. Main Outcome Measures: Most patients underwent bilateral simultaneous LASIK. Postoperative infection was signaled by the appearance of corneal infiltrates in the third postoperative week. The microbiologic workup was performed on cultures obtained either by direct scraping of the cornea or by lifting the flap. Medical therapy was instituted based on drug susceptibility testing. Surgical interventions such as corneal debridement and flap removal were performed during recurrences or when there was no satisfactory clinical response. Results: Cultures revealed Mycobacterium subspecies chelonae. Patients were treated with topical clarithromycin (1%), tobramycin (1.4%), and ofloxacin (0.3%). Oral clarithromycin (500 mg twice a day) was prescribed for those patients who did not respond clinically to topical treatment. Four eyes healed on this regimen. Flap removal was necessary in seven eyes. Conclusions: This report highlights mycobacteria as an etiologic infectious agent after LASIK. Diagnosis can be difficult and is often delayed. The treatment mainstay is prolonged antibiotic therapy. Surgical debridement and flap removal may shorten the disease course.

Original languageEnglish (US)
Pages (from-to)276-285
Number of pages10
JournalOphthalmology
Volume110
Issue number2
DOIs
StatePublished - Feb 1 2003

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Mycobacterium chelonae
Laser In Situ Keratomileusis
Mycobacterium Infections
Disease Outbreaks
Clarithromycin
Debridement
Surgical Flaps
Tobramycin
Ofloxacin
Keratitis
Therapeutics
Mycobacterium
Infection
Cornea
Outcome Assessment (Health Care)
Anti-Bacterial Agents
Recurrence
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Freitas, D., Alvarenga, L., Sampaio, J., Mannis, M. J., Sato, E., Sousa, L., ... Belfort, R. (2003). An outbreak of Mycobacterium chelonae infection after LASIK. Ophthalmology, 110(2), 276-285. https://doi.org/10.1016/S0161-6420(02)01643-3

An outbreak of Mycobacterium chelonae infection after LASIK. / Freitas, Denise; Alvarenga, Lênio; Sampaio, Jorge; Mannis, Mark J; Sato, Elcio; Sousa, Luciene; Vieira, Luiz; Yu, Maria C.; Martins, Maria C.; Hoffling-Lima, Ana; Belfort, Rubens.

In: Ophthalmology, Vol. 110, No. 2, 01.02.2003, p. 276-285.

Research output: Contribution to journalArticle

Freitas, D, Alvarenga, L, Sampaio, J, Mannis, MJ, Sato, E, Sousa, L, Vieira, L, Yu, MC, Martins, MC, Hoffling-Lima, A & Belfort, R 2003, 'An outbreak of Mycobacterium chelonae infection after LASIK', Ophthalmology, vol. 110, no. 2, pp. 276-285. https://doi.org/10.1016/S0161-6420(02)01643-3
Freitas D, Alvarenga L, Sampaio J, Mannis MJ, Sato E, Sousa L et al. An outbreak of Mycobacterium chelonae infection after LASIK. Ophthalmology. 2003 Feb 1;110(2):276-285. https://doi.org/10.1016/S0161-6420(02)01643-3
Freitas, Denise ; Alvarenga, Lênio ; Sampaio, Jorge ; Mannis, Mark J ; Sato, Elcio ; Sousa, Luciene ; Vieira, Luiz ; Yu, Maria C. ; Martins, Maria C. ; Hoffling-Lima, Ana ; Belfort, Rubens. / An outbreak of Mycobacterium chelonae infection after LASIK. In: Ophthalmology. 2003 ; Vol. 110, No. 2. pp. 276-285.
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abstract = "Objective: To describe an outbreak of mycobacterial keratitis after laser in situ keratomileusis (LASIK), including the microbiologic investigation, clinical findings, treatment response, and outcome. Design: Retrospective, noncomparative, interventional case series. Participants: Patients (n = 10) who underwent LASIK surgery between August 22 and September 4, 2000, and developed mycobacterial infection. Methods: Patients were prospectively followed in relation to microbiologic investigation, clinical findings, treatment response, and outcome. Main Outcome Measures: Most patients underwent bilateral simultaneous LASIK. Postoperative infection was signaled by the appearance of corneal infiltrates in the third postoperative week. The microbiologic workup was performed on cultures obtained either by direct scraping of the cornea or by lifting the flap. Medical therapy was instituted based on drug susceptibility testing. Surgical interventions such as corneal debridement and flap removal were performed during recurrences or when there was no satisfactory clinical response. Results: Cultures revealed Mycobacterium subspecies chelonae. Patients were treated with topical clarithromycin (1{\%}), tobramycin (1.4{\%}), and ofloxacin (0.3{\%}). Oral clarithromycin (500 mg twice a day) was prescribed for those patients who did not respond clinically to topical treatment. Four eyes healed on this regimen. Flap removal was necessary in seven eyes. Conclusions: This report highlights mycobacteria as an etiologic infectious agent after LASIK. Diagnosis can be difficult and is often delayed. The treatment mainstay is prolonged antibiotic therapy. Surgical debridement and flap removal may shorten the disease course.",
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AU - Sampaio, Jorge

AU - Mannis, Mark J

AU - Sato, Elcio

AU - Sousa, Luciene

AU - Vieira, Luiz

AU - Yu, Maria C.

AU - Martins, Maria C.

AU - Hoffling-Lima, Ana

AU - Belfort, Rubens

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N2 - Objective: To describe an outbreak of mycobacterial keratitis after laser in situ keratomileusis (LASIK), including the microbiologic investigation, clinical findings, treatment response, and outcome. Design: Retrospective, noncomparative, interventional case series. Participants: Patients (n = 10) who underwent LASIK surgery between August 22 and September 4, 2000, and developed mycobacterial infection. Methods: Patients were prospectively followed in relation to microbiologic investigation, clinical findings, treatment response, and outcome. Main Outcome Measures: Most patients underwent bilateral simultaneous LASIK. Postoperative infection was signaled by the appearance of corneal infiltrates in the third postoperative week. The microbiologic workup was performed on cultures obtained either by direct scraping of the cornea or by lifting the flap. Medical therapy was instituted based on drug susceptibility testing. Surgical interventions such as corneal debridement and flap removal were performed during recurrences or when there was no satisfactory clinical response. Results: Cultures revealed Mycobacterium subspecies chelonae. Patients were treated with topical clarithromycin (1%), tobramycin (1.4%), and ofloxacin (0.3%). Oral clarithromycin (500 mg twice a day) was prescribed for those patients who did not respond clinically to topical treatment. Four eyes healed on this regimen. Flap removal was necessary in seven eyes. Conclusions: This report highlights mycobacteria as an etiologic infectious agent after LASIK. Diagnosis can be difficult and is often delayed. The treatment mainstay is prolonged antibiotic therapy. Surgical debridement and flap removal may shorten the disease course.

AB - Objective: To describe an outbreak of mycobacterial keratitis after laser in situ keratomileusis (LASIK), including the microbiologic investigation, clinical findings, treatment response, and outcome. Design: Retrospective, noncomparative, interventional case series. Participants: Patients (n = 10) who underwent LASIK surgery between August 22 and September 4, 2000, and developed mycobacterial infection. Methods: Patients were prospectively followed in relation to microbiologic investigation, clinical findings, treatment response, and outcome. Main Outcome Measures: Most patients underwent bilateral simultaneous LASIK. Postoperative infection was signaled by the appearance of corneal infiltrates in the third postoperative week. The microbiologic workup was performed on cultures obtained either by direct scraping of the cornea or by lifting the flap. Medical therapy was instituted based on drug susceptibility testing. Surgical interventions such as corneal debridement and flap removal were performed during recurrences or when there was no satisfactory clinical response. Results: Cultures revealed Mycobacterium subspecies chelonae. Patients were treated with topical clarithromycin (1%), tobramycin (1.4%), and ofloxacin (0.3%). Oral clarithromycin (500 mg twice a day) was prescribed for those patients who did not respond clinically to topical treatment. Four eyes healed on this regimen. Flap removal was necessary in seven eyes. Conclusions: This report highlights mycobacteria as an etiologic infectious agent after LASIK. Diagnosis can be difficult and is often delayed. The treatment mainstay is prolonged antibiotic therapy. Surgical debridement and flap removal may shorten the disease course.

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