A Cluster of cases of Mycobacterium szulgai keratitis that occurred after laser-assisted in situ keratomileusis

Clin Infect Dis. 2002 Apr 15;34(8):1039-46. doi: 10.1086/339487. Epub 2002 Mar 11.

Abstract

Laser-assisted in situ keratomileusis (LASIK) is a recently developed ophthalmic procedure. When 2 patients developed keratitis caused by Mycobacterium szulgai after they underwent LASIK surgery, we conducted a retrospective cohort study of all LASIK procedures performed at Scott & White Clinic (Temple, Texas) during a 4.5-month period. Seven patients had compatible symptoms and signs, 5 of whom had confirmed M. szulgai keratitis. Five cases occurred among 30 procedures performed by doctor A, and there were no cases among 62 procedures performed by doctor B (approximate relative risk, 12.0; 95% confidence interval, 1.6-679.0; P=.0029). Doctor A had chilled syringes of saline solution in ice for intraoperative lavage-the only factor that differentiated the procedures of the 2 surgeons. Cultures of samples from the source ice machine's drain identified M. szulgai; the strain was identical to isolates recovered from all confirmed cases and differed from 4 standard M. szulgai strains, as determined by pulsed-field gel electrophoresis. Intraoperative contamination from ice water apparently led to M. szulgai keratitis in these patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cohort Studies
  • Equipment Contamination
  • Female
  • Humans
  • Keratitis / epidemiology*
  • Keratitis / microbiology
  • Keratomileusis, Laser In Situ / adverse effects*
  • Male
  • Middle Aged
  • Nontuberculous Mycobacteria*
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / microbiology
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome