Case Study: April 2012


  • A 30 year old undergoes LASIK for myopia and 2 weeks later, the vision goes off.
  • An infiltrate is noted beneath the flap.
  • The patient returns to theatre where the surgeon irrigates under the flap and antibiotics are started.
  • The vision continues to deteriorate-the surgeons elects to decapitate the flap.
  • The histology of the flap is shown.


  1. What is present at the deep aspect of the flap?
  2. Which organisms are seen in Fig 2?
  3. Which other organism is in the main differential?
Click to show answers
  1. Inflammation-this was mixed.
  2. These are atypical mycobacteria (ZN stain).
  3. Nocardia-although this is branching and positive for gram, silver and weakly acid-fast.


  1. Microbial keratitis after corneal laser refractive surgery.
    Sharma DP, Sharma S, Wilkins MR.
    Future Microbiol. 2011 Jul;6(7):819-31. Review.
  2. Microbial keratitis after LASIK.
    Garg P, Chaurasia S, Vaddavalli PK, Muralidhar R, Mittal V, Gopinathan U.
    J Refract Surg. 2010 Mar;26(3):209-16.
  3. Mycobacterium chelonae keratitis following laser in situ keratomileusis.
    Reviglio V, Rodriguez ML, Picotti GS, Paradello M, Luna JD, Juárez CP.
    J Refract Surg. 1998 May-Jun;14(3):357-60
  4. Mycobacterium chelonae keratitis after laser in situ keratomileusis successfully treated with medical therapy and flap removal.
    Chung MS, Goldstein MH, Driebe WT Jr, Schwartz BH.
    Am J Ophthalmol. 2000 Mar;129(3):382-4.
  5. Mycobacterium interface keratitis after laser in situ keratomileusis.
    Solomon A, Karp CL, Miller D, Dubovy SR, Huang AJ, Culbertson WW.
    Ophthalmology. 2001 Dec;108(12):2201-8