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Case Study: April 2012
History
- 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.
Questions
- What is present at the deep aspect of the flap?
- Which organisms are seen in Fig 2?
- Which other organism is in the main differential?
Click to show answers
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- Inflammation-this was mixed.
- These are atypical mycobacteria (ZN stain).
- Nocardia-although this is branching and positive for gram, silver and weakly acid-fast.
References
- Microbial keratitis after corneal laser refractive surgery.
Sharma DP, Sharma S, Wilkins MR.
Future Microbiol. 2011 Jul;6(7):819-31. Review. - 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. - 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 - 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. - 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
