Solomon A, Karp C L, Miller D, Dubovy S R, Huang A J, Culbertson W W
Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 17th Street, Miami, FL 33136, USA.
Ophthalmology. 2001 Dec;108(12):2201-8. doi: 10.1016/s0161-6420(01)00851-x.
To report the clinical course, management, and outcome of infectious interface keratitis caused by mycobacterium species after laser in situ keratomileusis (LASIK).
A small noncomparative interventional case series.
Five eyes in four patients who underwent LASIK in different locations around the world and had culture-positive mycobacterium keratitis develop.
The LASIK flap was lifted or amputated, samples were submitted for Ziehl-Neelsen acid-fast stain and Lowenstein-Jensen's agar cultures for diagnosis; topical treatment with fortified clarithromycin and amikacin was administered until clinical resolution.
Time periods from onset to diagnosis and from diagnosis to clinical resolution, and the final visual acuity.
Onset of symptoms of infection occurred after a mean of 20 days (range, 11 days-6 weeks) after LASIK or an enhancement procedure. Definitive diagnosis was obtained after a mean period of 4.5 weeks (range, 12 days-8 weeks) from onset. Keratitis resolved within 8.4 weeks (range, 1-18 weeks) of treatment with fortified clarithromycin and amikacin. Corticosteroids were found to worsen and prolong the course of disease. In four of five eyes the LASIK flap was amputated.
Mycobacterial keratitis is a potentially vision-threatening complication after LASIK, characterized by a long latent period, delayed diagnosis, and a protracted course even under intensive specific antibiotic therapy. Inclusion of specific culture media and staining protocols for mycobacteria, along with aggressive treatment on diagnosis, including lifting or amputating the LASIK flap, culturing, topical fortified clarithromycin and amikacin, while avoiding corticosteroids, may significantly improve resolution of the infection and potentially improve the visual outcome.
报告准分子原位角膜磨镶术（LASIK）后由分枝杆菌属引起的感染性界面性角膜炎的临床病程、治疗及预后。
一项小型非对照干预性病例系列研究。
4例患者的5只眼，这些患者在世界各地不同地点接受了LASIK手术，并发生了培养阳性的分枝杆菌性角膜炎。
掀起或切除LASIK瓣，送检标本进行萋-尼抗酸染色及罗氏培养基培养以明确诊断；局部应用强化克拉霉素和阿米卡星治疗，直至临床症状消退。
从发病到诊断以及从诊断到临床治愈的时间，以及最终视力。
感染症状平均在LASIK或增效手术后20天（范围11天至6周）出现。从发病到确诊平均用时4.5周（范围12天至8周）。强化克拉霉素和阿米卡星治疗8.4周（范围1至18周）内角膜炎消退。发现使用糖皮质激素会使病程恶化并延长。5只眼中有4只切除了LASIK瓣。
分枝杆菌性角膜炎是LASIK术后一种潜在的视力威胁性并发症，其特点是潜伏期长、诊断延迟，即使在强化特异性抗生素治疗下病程也较长。采用针对分枝杆菌的特定培养基和染色方法，以及诊断后积极治疗，包括掀起或切除LASIK瓣并进行培养，局部应用强化克拉霉素和阿米卡星，同时避免使用糖皮质激素，可能会显著提高感染的治愈率，并有可能改善视力预后。
