Murthy Somasheila I, Jain Rajat, Swarup Rishi, Sangwan Virender S
Cornea and Anterior Segment Service, LV Prasad Eye Institute, Hyderabad, Andrapradesh, India.
BMJ Case Rep. 2013 Oct 17;2013:bcr2013200641. doi: 10.1136/bcr-2013-200641.
A 26-year-old farmer underwent deep anterior lamellar keratoplasty (DALK) for keratoconus. After 3 months, he presented with interface keratitis. Medical treatment failed and he underwent a repeat DALK. Microbiological scrapings from the interface revealed an infection caused by non-tuberculous mycobacteria. Despite the use of intensive antibiotic therapy and a repeat lamellar keratoplasty, the infiltrates recurred. The patient underwent therapeutic penetrating keratoplasty. Microbiology of the corneal tissue revealed growth of Mycobacterium chelonae, and on histopathology, the acid-fast bacilli were noted to be located deep at the pre-Descemet level. There was complete resolution of the infection with no episodes of recurrence and final best-corrected visual acuity was 20/40 at 1 year of follow-up. Medical therapy is unlikely to succeed in post-DALK interface keratitis and penetrating rather than lamellar keratoplasty may be considered the surgery of choice.
一名26岁的农民因圆锥角膜接受了深板层角膜移植术（DALK）。3个月后，他出现了界面性角膜炎。药物治疗失败后，他再次接受了DALK。从界面刮取的微生物样本显示感染由非结核分枝杆菌引起。尽管使用了强化抗生素治疗并再次进行了板层角膜移植术，但浸润仍复发。该患者接受了治疗性穿透性角膜移植术。角膜组织的微生物学检查显示龟分枝杆菌生长，组织病理学检查发现抗酸杆菌位于后弹力层前的深部。感染完全消退，无复发，随访1年时最终最佳矫正视力为20/40。对于DALK术后界面性角膜炎，药物治疗不太可能成功，穿透性角膜移植术而非板层角膜移植术可能被视为首选手术。
