Infectious keratitis outbreak after laser in situ keratomileusis at a single laser center in Japan

Takefumi Yamaguchi, Hiroko Bissen-Miyajima, Yoshiko Hori-Komai, Yukihiro Matsumoto, Nobuyuki Ebihara, Hiroshi Takahashi, Kazuo Tsubota, Jun Shimazaki

Research output: Contribution to journalArticle

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Abstract

Purpose: To evaluate an outbreak of infectious keratitis after laser in situ keratomileusis (LASIK) at a single laser center in Japan. Setting: Tokyo Dental College, Chiba, Japan. Design: Case series. Methods: Relevant demographic and clinical data were obtained from case records using a standardized multicenter questionnaire at 12 major hospitals. The clinical manifestations, management, and outcomes were analyzed. Results: Thirty-nine eyes of 30 patients developed infectious keratitis after LASIK at the specified clinic. Cases of infection continued to appear over a 5-month period. The most common interval between LASIK and the onset of infection was within 2 weeks (36 eyes, 92.3%). Slitlamp manifestation included granular opacity beneath flap (71.8%), multiple infiltration (66.7%), and epithelial defect (30.8%). Mycobacterium was identified as the causative organism in 9 eyes (23.1%). In most cases, topical amikacin, arbekacin, and erythromycin in addition to fourth-generation fluoroquinolones were effective. Flap amputation was necessary in 10 eyes (25.6%) of 10 patients. Decimal visual acuity at initial presentation was worse than 0.10 in 14 eyes (35.9%), 0.15 to 0.50 in 8 eyes (20.5%), and 0.60 to 0.90 in 7 eyes (17.9%) and was better than 1.00 in 10 eyes (25.6%). Final decimal visual acuity was worse than 0.10 in 2 eyes (5.1%), 0.15 to 0.50 in 5 eyes (12.8%), and 0.60 to 0.90 in 11 eyes (28.2%) and was better than 1.00 in 21 eyes (53.8%). Conclusions: Mycobacterium was identified as the causative organism of this outbreak. This study shows the possibility of an epidemic of post-LASIK infectious keratitis. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Original languageEnglish
Pages (from-to)894-900
Number of pages7
JournalJournal of Cataract and Refractive Surgery
Volume37
Issue number5
DOIs
Publication statusPublished - 2011 May

Fingerprint

Laser In Situ Keratomileusis
Keratitis
Disease Outbreaks
Japan
Lasers
Mycobacterium
Visual Acuity
Amikacin
Tokyo
Fluoroquinolones
Disclosure
Erythromycin
Infection
Amputation
Tooth

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Surgery

Cite this

Yamaguchi, T., Bissen-Miyajima, H., Hori-Komai, Y., Matsumoto, Y., Ebihara, N., Takahashi, H., ... Shimazaki, J. (2011). Infectious keratitis outbreak after laser in situ keratomileusis at a single laser center in Japan. Journal of Cataract and Refractive Surgery, 37(5), 894-900. https://doi.org/10.1016/j.jcrs.2010.11.034

Infectious keratitis outbreak after laser in situ keratomileusis at a single laser center in Japan. / Yamaguchi, Takefumi; Bissen-Miyajima, Hiroko; Hori-Komai, Yoshiko; Matsumoto, Yukihiro; Ebihara, Nobuyuki; Takahashi, Hiroshi; Tsubota, Kazuo; Shimazaki, Jun.

In: Journal of Cataract and Refractive Surgery, Vol. 37, No. 5, 05.2011, p. 894-900.

Research output: Contribution to journalArticle

Yamaguchi, T, Bissen-Miyajima, H, Hori-Komai, Y, Matsumoto, Y, Ebihara, N, Takahashi, H, Tsubota, K & Shimazaki, J 2011, 'Infectious keratitis outbreak after laser in situ keratomileusis at a single laser center in Japan', Journal of Cataract and Refractive Surgery, vol. 37, no. 5, pp. 894-900. https://doi.org/10.1016/j.jcrs.2010.11.034
Yamaguchi, Takefumi ; Bissen-Miyajima, Hiroko ; Hori-Komai, Yoshiko ; Matsumoto, Yukihiro ; Ebihara, Nobuyuki ; Takahashi, Hiroshi ; Tsubota, Kazuo ; Shimazaki, Jun. / Infectious keratitis outbreak after laser in situ keratomileusis at a single laser center in Japan. In: Journal of Cataract and Refractive Surgery. 2011 ; Vol. 37, No. 5. pp. 894-900.
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abstract = "Purpose: To evaluate an outbreak of infectious keratitis after laser in situ keratomileusis (LASIK) at a single laser center in Japan. Setting: Tokyo Dental College, Chiba, Japan. Design: Case series. Methods: Relevant demographic and clinical data were obtained from case records using a standardized multicenter questionnaire at 12 major hospitals. The clinical manifestations, management, and outcomes were analyzed. Results: Thirty-nine eyes of 30 patients developed infectious keratitis after LASIK at the specified clinic. Cases of infection continued to appear over a 5-month period. The most common interval between LASIK and the onset of infection was within 2 weeks (36 eyes, 92.3{\%}). Slitlamp manifestation included granular opacity beneath flap (71.8{\%}), multiple infiltration (66.7{\%}), and epithelial defect (30.8{\%}). Mycobacterium was identified as the causative organism in 9 eyes (23.1{\%}). In most cases, topical amikacin, arbekacin, and erythromycin in addition to fourth-generation fluoroquinolones were effective. Flap amputation was necessary in 10 eyes (25.6{\%}) of 10 patients. Decimal visual acuity at initial presentation was worse than 0.10 in 14 eyes (35.9{\%}), 0.15 to 0.50 in 8 eyes (20.5{\%}), and 0.60 to 0.90 in 7 eyes (17.9{\%}) and was better than 1.00 in 10 eyes (25.6{\%}). Final decimal visual acuity was worse than 0.10 in 2 eyes (5.1{\%}), 0.15 to 0.50 in 5 eyes (12.8{\%}), and 0.60 to 0.90 in 11 eyes (28.2{\%}) and was better than 1.00 in 21 eyes (53.8{\%}). Conclusions: Mycobacterium was identified as the causative organism of this outbreak. This study shows the possibility of an epidemic of post-LASIK infectious keratitis. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.",
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AU - Matsumoto, Yukihiro

AU - Ebihara, Nobuyuki

AU - Takahashi, Hiroshi

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