准分子原位角膜磨镶术同时术后发生的单侧真菌性和分枝杆菌性角膜炎
Unilateral fungal and mycobacterial keratitis after simultaneous laser in situ keratomileusis.
作者信息
Pache Mona, Schipper Isac, Flammer Josef, Meyer Peter
机构信息
University Eye Clinic, P.O. Box, CH-4012 Basel, Switzerland.
出版信息
Cornea. 2003 Jan;22(1):72-5. doi: 10.1097/00003226-200301000-00018.
PURPOSE
To report a case of unilateral fungal and mycobacterial keratitis after simultaneous laser in situ keratomileusis (LASIK).
METHODS
Case report of a 37-year-old woman who developed corneal infiltrates located at the flap-stroma interface in her left eye 3 weeks after LASIK for myopia. The infiltration progressed despite topical antibiotic therapy; therefore, the flap was lifted and irrigated with antibiotic solution. Parallel corneal scrapings were taken. The patient's condition deteriorated, prompting a lamellar keratoplasty.
RESULTS
Corneal scrapings demonstrated no growth. Microbiologic cultures of the corneal specimen were reported as negative, whereas histopathologic examination disclosed fungal filaments. Two months later, the patient presented corneal infiltrates of the left eye again. Because the situation worsened despite therapy, a penetrating keratoplasty was performed. Histopathologic examination of the host cornea revealed no pathogenic species; microbiologic cultures, however, demonstrated Mycobacterium chelonae.
CONCLUSION
Fungi and M. chelonae are rare and insidious causes of infectious keratitis after LASIK. Our case emphasizes the possible difficulties in diagnosing and treating a combined or subsequent infection with both species.
目的
报告一例准分子原位角膜磨镶术（LASIK）后发生单侧真菌和分枝杆菌性角膜炎的病例。
方法
病例报告，一名37岁女性，近视行LASIK术后3周，左眼瓣 - 基质界面出现角膜浸润。尽管局部应用抗生素治疗，浸润仍进展；因此，掀起角膜瓣并用抗生素溶液冲洗。并行角膜刮片检查。患者病情恶化，遂行板层角膜移植术。
结果
角膜刮片无生长。角膜标本的微生物培养报告为阴性，而组织病理学检查发现真菌丝。两个月后，患者左眼再次出现角膜浸润。尽管治疗但病情仍恶化，遂行穿透性角膜移植术。宿主角膜的组织病理学检查未发现致病菌种；然而，微生物培养显示为龟分枝杆菌。
结论
真菌和龟分枝杆菌是LASIK后感染性角膜炎的罕见且隐匿的病因。我们的病例强调了诊断和治疗这两种菌种合并或后续感染可能存在的困难。
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