Javadi Mohammad-Ali, Kanavi Mozhgan Rezaei, Zarei-Ghanavati Siamak, Mirbabaei Firooz, Jamali Hosein, Shoja Mohamadreza, Mahdavi Manijeh, Naghshgar Nima, Yazdani Shahin, Faramarzi Amir
Labbafinejad Ophthalmic Research Center, Shaheed Beheshti Medical University, Tehran, Iran.
J Cataract Refract Surg. 2009 Feb;35(2):393-8. doi: 10.1016/j.jcrs.2008.08.045.
Nocardia keratitis occurred in 4 eyes of 3 patients (2 women and 1 man) who had photorefractive keratectomy (PRK) by the same surgeon at the same center. Two eyes of the first 2 patients required lamellar keratectomy to debulk the involved stroma and obtain specimens for microbiological and histopathological evaluation. Light microscopic examination disclosed gram-positive and acid-fast filaments of Nocardia that were confirmed by the microbiological results. Diagnosis of Nocardia keratitis in the third case was not as challenging as in the first 2 cases because of a high index of suspicion. Confocal scans of all cases disclosed hyperreflective and slender, fibril-like structures in the corneal stroma. All eyes responded favorably to topical amikacin and the infection resolved without recurrence. The most probable cause of the outbreak was inadequate attention to sterility during surgery.
3例患者（2名女性和1名男性）在同一中心由同一位外科医生进行了准分子激光角膜切削术（PRK）后，有4只眼发生了诺卡菌性角膜炎。前2例患者的2只眼需要进行板层角膜切除术以去除受累基质并获取标本进行微生物学和组织病理学评估。光镜检查发现诺卡菌的革兰氏阳性和抗酸丝状菌，微生物学结果证实了这一点。由于高度怀疑，第三例诺卡菌性角膜炎的诊断不像前两例那样具有挑战性。所有病例的共焦扫描均显示角膜基质中有高反射性且细长的纤维状结构。所有眼睛对局部使用阿米卡星反应良好，感染消退且无复发。此次暴发最可能的原因是手术过程中对无菌操作的关注不足。
