<i>Mycobacterium abscessus</i> Keratitis after LASIK with IntraLase^® Femtosecond Laser

Abstract

A healthy 38-year-old woman developed 2 white spots in her left eye 2 weeks after bilateral laser in situ keratomileusis (LASIK) using the IntraLase^® femtosecond laser. Initial treatment included levofloxacin 0.5% but was unsuccessful. The surgeon irrigated the interface and repositioned the flap due to a worsened lesion. She was referred to us after the keratitis had not improved. The flap was lifted for collection of the specimen and irrigation of the interface. The keratitis was treated with intensive topical clarithromycin 1%, amikacin 1.25% and oral clarithromycin, which improved her clinical condition. She developed a toxic reaction to amikacin 1.25%, which was replaced by moxifloxacin 0.5%. Mycobacterium abscessus was identified. The keratitis resolved over 2 months. Five months after treatment, the patient had a visual acuity of 20/20 with correction. Nontuberculous mycobacteria should be considered as an etiologic agent, even in cases of infectious keratitis after LASIK using the femtosecond laser.

Epithelial breakthrough during IntraLase flap creation for laser in situ keratomileusis

“…4,5 Complications associated with FS corneal flap creation include diffuse lamellar keratitis, macular hemorrhage, and anterior chamber gas bubbles. [6][7][8][9][10][11][12] Partial-thickness vertical gas breakthrough has been described in one patient. 13 In this case series, we describe full-thickness epithelial breakthrough in 4 LASIK patients who had flap creation with the IntraLase FS laser.…”

Activities of Moxifloxacin in Combination with Macrolides against Clinical Isolates of Mycobacterium abscessus and Mycobacterium massiliense

“…A recent prospective observational study demonstrated that CLR-MXF combination therapy for postacupuncture cutaneous M. abscessus infections resulted in a more rapid resolution of the cutaneous lesions than did the use of a CLR-amikacin combination (9). Moreover, MXF has been shown to be effective against experimentally induced M. abscessus keratitis and in human cases of that disorder (7,10,37). However, MXF obviously interferes with CLR activity in over 65% of the tested strains of M. abscessus in our models, indicating that many factors should be considered in explaining such a different result.…”

Second femtosecond laser pass for incomplete laser in situ keratomileusis flaps caused by suction loss

“…[5][6][7] However, complications associated with femtosecond laser corneal flap creation include diffuse lamellar keratitis, macular hemorrhage, and anterior chamber gas bubbles. [11][12][13][14][15][16][17] In addition, incomplete flaps can occur, mainly due to suction loss. Although there is no definitive evidence implicating a specific etiologic factor, suction loss can be attributed to the patient squeezing the eyelid, conjunctival chemosis, and epithelial breakthrough, 18 among other causes.…”