Mycobacterium chelonae keratiti after laer in itu keratomileui uccefully treated with medical therapy and flap removal

PURPOE To report a cae of Mycobacterium chelonae keratiti after laer in itu keratomileui uccefully treated with medical therapy and flap removal. METHOD Cae report. A 36-year-old white woman in good health developed a paracentral keratiti in her right eye 1 month after bilateral laer in itu keratomileui. Initial treatment included topical teroid and then intenive Ocuflox (ofloxacin ophthalmic olution; Allergan, Inc, Irvine, California) without ucce. Culture were negative. The keratiti worened, and he wa referred to our intitution. Interface infiltration wa noted, and the flap wa lifted to obtain adequate laboratory tudie. Culture were poitive for M chelonae. REULT The keratiti wa treated with intenive topical amikacin ulfate 1%, topical clarithromycin 1%, and Ciloxan (ciprofloxacin HCL; Alcon Laboratorie, Inc, Fort Worth, Texa) with minimal improvement in her clinical condition. he developed a toxic reaction to amikacin 1%. In order to improve antibiotic penetration, the hazy, ulcerated corneal flap wa removed. The keratiti then reolved with intenive topical clarithromycin 1% and Ocuflox over 5 week. The patient now ha viual acuity without correction of 20/50, depite uperficial corneal haze. CONCLUION M chelonae i a rare and inidiou caue of infection after laer in itu keratomileui. Diagnoi can be difficult and i often delayed. Aggreive medical management, with flap removal, if needed, may lead to reolution of infection.