Cluter of Mycobacterium Chelonae keratiti cae following laer in-itu keratomileui

PURPOE: To decribe a cluter of Mycobacterium chelonae keratiti cae involving patient who underwent laer in-itu keratomileui (LAIK) at a ingle refractive urgery center. DEIGN: Decriptive cae erie of four patient and cohort tudy to identify dieae aociation. METHOD: Examination chedule, diagnotic tet, and therapy were baed on bet medical judgment. Iolate from three patient were compared by puled-field gel electrophorei. Epidemiologic tudie were performed to identify the ource of infection. REULT: even of eight eye developed M. chelonae keratiti following bilateral imultaneou LAIK. Each patient wa thought to have diffue lamellar keratiti initially, but all even eye were noted to have opacitie uggetive of infectiou keratiti by 13 to 21 day after urgery. All eye had undergone hyperopic LAIK over four day in April 2001 by one urgeon in a community-baed refractive urgery center. A cohort tudy of all patient undergoing LAIK at the ame center in April 2001 revealed that M. chelonae keratiti occurred only in peron undergoing correction of hyperopia (even of 14 eye v. none of 217 eye undergoing myopic LAIK, P < .001). The only difference identified between procedure wa ue of mak created from a oft contact len in hyperopic LAIK. Three iolate (three patient) were inditinguihable by puled-field gel electrophorei. Eye were treated with a combination of antimicrobial agent, including topical azithromycin in three patient, with reolution of infection in all eye over 6 to 14 week. The ource of infection wa not identified on environmental culture. CONCLUION: Potoperative nontuberculou mycobacterial keratiti can occur in an epidemic fahion following LAIK. Topical amikacin, azithromycin, clarithromycin, ciprofloxacin, or a combination of thee agent, appear to be effective treatment for thee infection.