Ferrer Consuelo, Rodríguez-Prats Jose L, Abad José L, Alió Jorge L
Departmento Biología Molecular, Instituto Oftalmológico de Alicante, Avenida de Denia no 111, 03015 Alicante, Spain.
J Cataract Refract Surg. 2004 Aug;30(8):1790-4. doi: 10.1016/j.jcrs.2003.11.058.
Laser in situ keratomileusis (LASIK) was performed in the left eye of a 57-year-old man for residual ametropia after phacoemulsification. The patient was given topical tobramycin and a corticosteroid for 1 week postoperatively. Fifteen days later, he developed 3 corneal infiltrates beneath the flap with a gas bubble, suggesting an anaerobic infection. Tobramycin and ofloxacin were administered every 2 hours, but the condition worsened. Corneal scrapings were taken from beneath the flap for microbiological cultures and a polymerase chain reaction (PCR) test. The PCR amplification was negative for fungi and mycobacteria and positive for bacterial DNA. Sequence analysis showed Propionibacterium granulosum as the causal agent, but cultures were negative. Treatment with vancomycin and cefazolin led to clinical improvement, with resolution of corneal infiltrates. Anaerobic microorganisms can cause keratitis after LASIK. Polymerase chain reaction amplification and DNA typing can help detect microorganisms involved in these ocular infections.
一名57岁男性因白内障超声乳化术后残余屈光不正，接受了左眼准分子原位角膜磨镶术（LASIK）。术后患者接受了为期1周的局部妥布霉素和皮质类固醇治疗。15天后，他在角膜瓣下出现3处伴有气泡的角膜浸润，提示厌氧菌感染。每2小时给予妥布霉素和氧氟沙星治疗，但病情恶化。从角膜瓣下取角膜刮片进行微生物培养和聚合酶链反应（PCR）检测。PCR扩增结果显示真菌和分枝杆菌为阴性，细菌DNA为阳性。序列分析显示颗粒丙酸杆菌为病原体，但培养结果为阴性。使用万古霉素和头孢唑林治疗后临床症状改善，角膜浸润消退。厌氧菌可导致LASIK术后角膜炎。聚合酶链反应扩增和DNA分型有助于检测这些眼部感染中涉及的微生物。
