J Refract Surg. 2013 Nov;29(11):788-90. doi: 10.3928/1081597X-20130917-01. Epub 2013 Sep 24.
To describe the clinical stages and management of Achromobacter xylosoxidans keratitis with post-LASIK epithelial ingrowth in two patients.
Retrospective chart review.
Both patients had been treated with topical antibiotics and corticosteroids for several weeks prior to presentation. Examination at presentation revealed significant areas of epithelial ingrowth without signs of acute inflammation, prompting an erroneous initial diagnosis of recurrent corneal erosion. A corneal infiltrate was eventually observed and A. xylosoxidans was cultured from both patients. Clinical resolution occurred with treatment consisting of topical fortified antibiotics. In one patient, the flap was lifted to obtain cultures and irrigate the stromal bed with fortified antibiotics.
Post-LASIK epithelial ingrowth may have served as a risk factor for A. xylosoxidans infection. Classic signs of infectious keratitis were absent, delaying the diagnosis. Three clinical stages described herein may assist the clinician with diagnosis and customized management obviating the need for penetrating keratoplasty.
描述 2 例 LASIK 后上皮内植入伴阿克曼菌角膜炎的临床分期和治疗。
回顾性病例分析。
就诊前，这 2 位患者均已接受数周的局部抗生素和皮质类固醇治疗。就诊时检查发现明显的上皮内植入，无急性炎症迹象，导致最初误诊为复发性角膜糜烂。最终观察到角膜浸润，从这 2 位患者中均培养出阿克曼菌。经局部强化抗生素治疗后，临床症状得到缓解。在 1 位患者中，掀起角膜瓣以获取培养物，并使用强化抗生素冲洗基质床。
LASIK 后上皮内植入可能是阿克曼菌感染的危险因素。典型的感染性角膜炎体征缺失，导致诊断延迟。本文描述的 3 个临床阶段可能有助于临床医生进行诊断和个体化治疗，避免穿透性角膜移植的需要。
