Cluster of Mycobacterium chelonae keratitis cases following laser in-situ keratomileusis

Naveen S. Chandra, Mark F. Torres, Kevin Winthrop, David A. Bruckner, David G. Heidemann, Helene M. Calvet, Mitchell Yakrus, Bartly J. Mondino, Gary N. Holland

Research output: Contribution to journalArticle

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Abstract

PURPOSE: To describe a cluster of Mycobacterium chelonae keratitis cases involving patients who underwent laser in-situ keratomileusis (LASIK) at a single refractive surgery center. DESIGN: Descriptive case series of four patients and cohort study to identify disease associations. METHODS: Examination schedules, diagnostic tests, and therapy were based on best medical judgment. Isolates from three patients were compared by pulsed-field gel electrophoresis. Epidemiologic studies were performed to identify the source of infection. RESULTS: Seven of eight eyes developed M. chelonae keratitis following bilateral simultaneous LASIK. Each patient was thought to have diffuse lamellar keratitis initially, but all seven eyes were noted to have opacities suggestive of infectious keratitis by 13 to 21 days after surgery. All eyes had undergone hyperopic LASIK over four days in April 2001 by one surgeon in a community-based refractive surgery center. A cohort study of all patients undergoing LASIK at the same center in April 2001 revealed that M. chelonae keratitis occurred only in persons undergoing correction of hyperopia (seven of 14 eyes vs. none of 217 eyes undergoing myopic LASIK, P <.001). The only difference identified between procedures was use of masks created from a soft contact lens in hyperopic LASIK. Three isolates (three patients) were indistinguishable by pulsed-field gel electrophoresis. Eyes were treated with a combination of antimicrobial agents, including topical azithromycin in three patients, with resolution of infection in all eyes over 6 to 14 weeks. The source of infection was not identified on environmental cultures. CONCLUSION: Postoperative nontuberculous mycobacterial keratitis can occur in an epidemic fashion following LASIK. Topical amikacin, azithromycin, clarithromycin, ciprofloxacin, or a combination of these agents, appears to be effective treatment for these infections.

Original languageEnglish (US)
Pages (from-to)819-830
Number of pages12
JournalAmerican Journal of Ophthalmology
Volume132
Issue number6
DOIs
StatePublished - 2001
Externally publishedYes

Fingerprint

Mycobacterium chelonae
Laser In Situ Keratomileusis
Keratitis
Refractive Surgical Procedures
Azithromycin
Pulsed Field Gel Electrophoresis
Infection
Cohort Studies
Hyperopia
Hydrophilic Contact Lens
Clarithromycin
Amikacin
Ciprofloxacin
Masks
Anti-Infective Agents
Ambulatory Surgical Procedures
Routine Diagnostic Tests
Epidemiologic Studies
Appointments and Schedules
Therapeutics

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Chandra, N. S., Torres, M. F., Winthrop, K., Bruckner, D. A., Heidemann, D. G., Calvet, H. M., ... Holland, G. N. (2001). Cluster of Mycobacterium chelonae keratitis cases following laser in-situ keratomileusis. American Journal of Ophthalmology, 132(6), 819-830. https://doi.org/10.1016/S0002-9394(01)01267-3

Cluster of Mycobacterium chelonae keratitis cases following laser in-situ keratomileusis. / Chandra, Naveen S.; Torres, Mark F.; Winthrop, Kevin; Bruckner, David A.; Heidemann, David G.; Calvet, Helene M.; Yakrus, Mitchell; Mondino, Bartly J.; Holland, Gary N.

In: American Journal of Ophthalmology, Vol. 132, No. 6, 2001, p. 819-830.

Research output: Contribution to journalArticle

Chandra, NS, Torres, MF, Winthrop, K, Bruckner, DA, Heidemann, DG, Calvet, HM, Yakrus, M, Mondino, BJ & Holland, GN 2001, 'Cluster of Mycobacterium chelonae keratitis cases following laser in-situ keratomileusis', American Journal of Ophthalmology, vol. 132, no. 6, pp. 819-830. https://doi.org/10.1016/S0002-9394(01)01267-3
Chandra, Naveen S. ; Torres, Mark F. ; Winthrop, Kevin ; Bruckner, David A. ; Heidemann, David G. ; Calvet, Helene M. ; Yakrus, Mitchell ; Mondino, Bartly J. ; Holland, Gary N. / Cluster of Mycobacterium chelonae keratitis cases following laser in-situ keratomileusis. In: American Journal of Ophthalmology. 2001 ; Vol. 132, No. 6. pp. 819-830.
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AU - Torres, Mark F.

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AU - Heidemann, David G.

AU - Calvet, Helene M.

AU - Yakrus, Mitchell

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N2 - PURPOSE: To describe a cluster of Mycobacterium chelonae keratitis cases involving patients who underwent laser in-situ keratomileusis (LASIK) at a single refractive surgery center. DESIGN: Descriptive case series of four patients and cohort study to identify disease associations. METHODS: Examination schedules, diagnostic tests, and therapy were based on best medical judgment. Isolates from three patients were compared by pulsed-field gel electrophoresis. Epidemiologic studies were performed to identify the source of infection. RESULTS: Seven of eight eyes developed M. chelonae keratitis following bilateral simultaneous LASIK. Each patient was thought to have diffuse lamellar keratitis initially, but all seven eyes were noted to have opacities suggestive of infectious keratitis by 13 to 21 days after surgery. All eyes had undergone hyperopic LASIK over four days in April 2001 by one surgeon in a community-based refractive surgery center. A cohort study of all patients undergoing LASIK at the same center in April 2001 revealed that M. chelonae keratitis occurred only in persons undergoing correction of hyperopia (seven of 14 eyes vs. none of 217 eyes undergoing myopic LASIK, P <.001). The only difference identified between procedures was use of masks created from a soft contact lens in hyperopic LASIK. Three isolates (three patients) were indistinguishable by pulsed-field gel electrophoresis. Eyes were treated with a combination of antimicrobial agents, including topical azithromycin in three patients, with resolution of infection in all eyes over 6 to 14 weeks. The source of infection was not identified on environmental cultures. CONCLUSION: Postoperative nontuberculous mycobacterial keratitis can occur in an epidemic fashion following LASIK. Topical amikacin, azithromycin, clarithromycin, ciprofloxacin, or a combination of these agents, appears to be effective treatment for these infections.

AB - PURPOSE: To describe a cluster of Mycobacterium chelonae keratitis cases involving patients who underwent laser in-situ keratomileusis (LASIK) at a single refractive surgery center. DESIGN: Descriptive case series of four patients and cohort study to identify disease associations. METHODS: Examination schedules, diagnostic tests, and therapy were based on best medical judgment. Isolates from three patients were compared by pulsed-field gel electrophoresis. Epidemiologic studies were performed to identify the source of infection. RESULTS: Seven of eight eyes developed M. chelonae keratitis following bilateral simultaneous LASIK. Each patient was thought to have diffuse lamellar keratitis initially, but all seven eyes were noted to have opacities suggestive of infectious keratitis by 13 to 21 days after surgery. All eyes had undergone hyperopic LASIK over four days in April 2001 by one surgeon in a community-based refractive surgery center. A cohort study of all patients undergoing LASIK at the same center in April 2001 revealed that M. chelonae keratitis occurred only in persons undergoing correction of hyperopia (seven of 14 eyes vs. none of 217 eyes undergoing myopic LASIK, P <.001). The only difference identified between procedures was use of masks created from a soft contact lens in hyperopic LASIK. Three isolates (three patients) were indistinguishable by pulsed-field gel electrophoresis. Eyes were treated with a combination of antimicrobial agents, including topical azithromycin in three patients, with resolution of infection in all eyes over 6 to 14 weeks. The source of infection was not identified on environmental cultures. CONCLUSION: Postoperative nontuberculous mycobacterial keratitis can occur in an epidemic fashion following LASIK. Topical amikacin, azithromycin, clarithromycin, ciprofloxacin, or a combination of these agents, appears to be effective treatment for these infections.

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