A Rare Presentation Of Bilateral Atypical Mycobacterial Keratitis Post Lasik : A Case Report

To describe a rare presentation of bilateral atypical mycobacterial keratitis following LASIK

L V Prasad Eye Institute, Hyderabad (India)

We report a clinical case of a 33-year-old female with Atypical Mycobacterial Keratitis in both eyes

2 months after LASIK, done elsewhere and referred to our hospital for further management. Patient complained of blurring of

Vision and pain in the right eye (RE) since 2 weeks and was bring treated with topical antibiotics. Vision was noted as CFCF RE and 20/30 in the left eye (LE). On slit lamp examination, BE showed corneal infiltrates in the interface with flap thinning and stromal loss for which the patient underwent scraping and interface wash. Microbiological analysis revealed atypical mycobacteria, which was resistant to all antibiotics except for amikacin, hence the patient was started on hourly topical amikacin 2.5% and 1% Atropine. The patient began to show a slow and steady response to treatment and the keratitis began to resolve with vascularisation, interface haze and scarring and paracentral flap folds, with complete resolution noted after 3 months, with a final VA of 20/30 in the LE and 20/40 in RE. The patient is on topical lubricants presently and there have been no recurrences.

Corneal infections with a relatively unfamiliar organisms such as atypical mycobacteria after LASIK can be a significant cause of ocular morbidity in otherwise healthy, young individuals, due to improper management and can create a legally difficult situation for refractive surgeons. Atypical mycobacterial keratitis is the most common infection after LASIK, and the refractive surgeon should be familiar with its presentation and treatment. This case reports aims to show the common clinical presentation and highlight the importance of appropriate diagnostic modalities, antibiotic sensitivity testing and treatment in a case of bilateral atypical mycobacterial keratitis after LASIK.