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The purpose of this article was to report a case of unilateral late-onset nontuberculous mycobacterial keratitis after small incision lenticule extraction (SMILE).This was a case report.A 27-year-old woman presented with Mycobacterium chelonae keratitis 3 weeks after uncomplicated SMILE with a solitary interface infiltrate. The keratitis worsened after an initial response to topical fortified and interface antibiotic irrigation. Despite repeated interface irrigation and topical and oral antibiotics, progressive, diffuse stromal infiltrates followed by melting of the cap ensued over the next 6 weeks. Cap amputation and intrastromal antibiotic injection followed by prolonged topical and oral antibiotics usage for the following 5 weeks led to infiltrate resolution and re-epithelization of the residual stromal bed. All medications were tapered off over 6 months after initial presentation without recurrence, but anterior stromal scarring and corneal neovascularization persisted.Cap amputation and intrastromal antibiotic injection for intractable post-SMILE keratitis can prevent the need for therapeutic keratoplasty.

To report a case of unilateral fungal and mycobacterial keratitis after simultaneous laser in situ keratomileusis (LASIK).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.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.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.

To describe the time course, diagnosis, clinical features, and treatment of seven patients with Mycobacterium szulgai keratitis that developed from 7 to 24 weeks after laser in situ keratomileusis (LASIK).Seven of 30 eyes of 18 patients were identified with keratitis after LASIK. The first two patients presented 12 to 14 weeks after LASIK; nontuberculous mycobacteria were identified 1 month after the flaps were cultured. Patient recall identified three additional cases by culture and two cases by clinical features alone. Pulsed-field gel electrophoresis (PFGE) was used to type the isolates, and treatment was modified based on susceptibilities.M. szulgai was identified in five patients for whom cultures were performed, but response to empiric therapy based on cultures proved unsatisfactory. The keratitis resolved in all patients with treatment including clarithromycin based on susceptibilities. Medical therapy was sufficient, although one patient required flap amputation. Six of seven patients recovered best-corrected visual acuity (BCVA), while one patient lost one line of BCVA. Two patients lost one line of postoperative uncorrected visual acuity (UCVA), two patients gained one line of UCVA, and three patients recovered postoperative UCVA. PFGE analysis revealed that the M. szulgai strains were identical, and the infection source was contaminated ice used to chill syringes for saline lavage.Nontuberculous mycobacterial keratitis after LASIK is a diagnostic and management challenge, but outcomes can be preserved with treatment based on susceptibilities. This cluster underscores the importance of adherence to sterile protocol during LASIK.

A 25-year-old Vietnamese man who had bilateral simultaneous laser in situ keratomileusis (LASIK) for moderate myopia developed bilateral Mycobacterium abscessus keratitis that was treated with intensive medical therapy, flap removal, superficial keratectomy, and, following disease progression, therapeutic deep anterior lamellar keratoplasty (DALK). To our knowledge, this is the first reported case of bilateral post-LASIK mycobacterial keratitis successfully treated with DALK.

Mycobacterium species that are considered typical are the tuberculosis species such as M.tu‐ berculosis, M.bovis, M.africarium and M.leprae. These species have only human or animal res‐ ervoirs and are not transmitted by water. In contrast, the species Non-Tuberculosis or “atypical”, naturally are ubiquitous in soil and water and have been found as normal flora of skin, sputum, and gastric contents. These bacteria are resistant to common, disinfectants, chlorine, formaldehyde and glutaraldehyde.

PURPOSE The purpose of this study was to report on Tsukamurella as a mimic of atypical mycobacterial infection. METHODS We report a patient who had received repeated corneal grafts with culture-proven Tsukamurella keratitis. RESULTS A slow-progressing corneal abscess that initially developed adjacent to a corneal stitch responded poorly to empiric antibiotic treatment. A preliminary culture report revealed fast-growing mycobacterial species. Treatment adjustments successfully controlled the disease. A final diagnosis of Tsukamurella was subsequently made on the basis of cultures. CONCLUSIONS Tsukamurella exhibits laboratory similarities to mycobacteria and should be considered in the differential of atypical infection of the ocular surface.

This section provides guidelines on medical therapy of patients with infectious keratitis. In addition to initial empirical therapy, preferred medications, once the organisms responsible are isolated, are discussed. Atypical mycobacterial keratitis following lasik is described. General guidelines for supportive therapy and follow-up, of these patients are presented. Clinical response to treatment and indications for intervention are discussed. Possible causes and approach to cases refractory to medical therapy are discussed.

Purpose: Corneal infection with unfamiliar organisms such as nontuberculous (atypical) mycobacteria after laser in situ keratomileusis (LASIK) can be a significant clinical problem, and mismanagement of such corneal infection in an otherwise healthy, young individual can lead to significant medicolegal issues for the refractive surgeon. Because nontuberculous (atypical) mycobacterial keratitis is the most common infection after LASIK, the refractive surgeon should be aware of all aspects of this dreaded infection to be better prepared to manage such cases. Methods: Literature search. Results/Conclusions: This article provides a comprehensive compilation of all reported cases of nontuberculous (atypical) mycobacterial keratitis in the English literature and provides some useful recommendations for the clinical management of such corneal infection after LASIK.

We report the results of laser in situ keratomileusis (LASIK) in a 51-year-old woman with subsequent mycobacterial keratitis diagnosed by staining with acid-fast and fluorochrome methods, a technique known to have good sensitivity and specificity for mycobacteria. A rapid diagnosis was made without waiting for cultures, and treatment was instituted, including tapering of topical steroids and appropriate antibiotic therapy. The result was preservation of the LASIK flap and a favorable visual outcome at 6 months.

Canaliculitis and acute dacrocystitis have both been reported as complications of SmartPLUG™ (Medennium Inc., Irvine, California) insertion.1 2 We describe a case of concurrent Mycobacterium chelonae keratitis and canaliculitis in a patient with a SmartPLUG in the upper lid of the same eye. A 76-year-old woman with an indwelling canalicular plug developed progressive peripheral ulcerative keratitis of the left eye. During treatment for the keratitis she developed left upper lid canaliculitis (figure 1). Culture of corneal scrapings was positive for Mycobacteria chelonae . Material expressed from the left upper canaliculus was cultured and grew the same organism. Sensitivity evaluation revealed …

A 20-year-old man was evaluated for an indolent corneal ulcer. Tissue and cultures from a penetrating keratoplasty indicated that the causative agent was Mycobacterium gordonae. This is the third patient reported with M. gordonae keratitis, although there have been numerous reports of nontuberculous mycobacterial keratitis. Nontuberculous mycobacterial keratitis is typically associated with previous trauma. The patient reported here had no known predisposing factor.

We report a case of mycobacterial keratitis characterized by apparently spontaneous onset, delayed diagnosis, and eventually necessitating evisceration inspite of systemic antibiotics and repeated corneal grafts.

• We report two cases of nontuberculous mycobacterial keratitis. To our knowledge, case 1 is the first documented case of Mycobacterium chelonei sclerokeratitis and case 2 is the first report of Mycobacterium flavescens keratitis. A total of 40 cases of nontuberculous mycobacterial keratitis involving at least five different species have been reported previously in the literature. Almost all of these opportunistic infections have occurred following either accidental or surgical ocular trauma, usually associated with the use of local corticosteroids. Encountered infrequently, these organisms can be incorrectly identified as other bacteria, including diphtheroids and Nocardia species. Histopathologic examination and special stains of infected tissues may be helpful in establishing the correct diagnosis. Cultures and sensitivity testing are mandatory in determining appropriate treatment.

A case of marginal corneal abscess and hypopyon due to Mycobacterium chelonae is presented. Its therapy is described, followed by a brief discussion of atypical mycobacterial keratitis.