HOLMES GP, BOND GB, FADER R, FULCHER SF; Interscience Conference on Antimicrobial Agents and Chemotherapy (41st : 2001 : Chicago, Ill.).
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2001 Dec 16-19; 41: abstract no. K-478.
Scott & White Memorial Hospital and Clinic, Texas A&M Univ. System Health Sci. Ctr., Temple, TX
BACKGROUND: LASIK is a commonly performed procedure to correct myopia, hyperopia, and astigmatism, first described in 1990. It was first performed in our institution on June 6, 2000. In October, an intra-corneal infection caused by Mycobacterium szulgai was diagnosed, four months following LASIK. METHODS: Retrospective cohort study of all LASIK procedures between June 6-October 24, 2000, with follow-up through March 31, 2001. RESULTS: Five of 52 LASIK patients (9.6%) had confirmed post-operative M. szulgai keratitis. All 5 cases were identified among 18 patients (30 procedures) of Dr. A, and in 0 of 34 patients (62 procedures) of Dr. B (analyzed by patient: p = 0.0033; approximate RR = 10.8, 95% CI = 1.5 - 709.0; analyzed by individual LASIK procedure: p = 0.0029; approximate RR = 12.0, 95% CI = 1.6 - 679.0). Two other patients of Dr. A had similar corneal lesions that were not cultured, but were treated as probable cases. The surgeons techniques differed only in Dr. As use of saline lavage that was chilled in a tub of ice, while Dr. B used un-chilled saline directly from its stock bottle. Extensive environmental cultures were obtained. A culture from the drain of the source ice machine grew M. szulgai. Pulsed-field gel electrophoresis confirmed this to be identical to all 5 clinical isolates and different from the M. szulgai type strain (ATCC 35799) plus three randomly selected strains. CONCLUSIONS: Intra-operative contamination from ice water apparently caused a series of M. szulgai corneal infections following LASIK. This appears to be the first systematic epidemiologic investigation of an infection cluster following LASIK, and the first to link M. szulgai infection with an environmental source. Contaminated ice water from lavage syringes may be a significant and avoidable source of post-operative ophthalmic infection. Ice water is often contaminated, & should not be used in association with surgical procedures.
Publication Types:
Keywords:
- Astigmatism
- Cluster Analysis
- Cohort Studies
- Cornea
- Humans
- Hyperopia
- Keratitis
- Keratomileusis, Laser In Situ
- Keratoplasty, Penetrating
- Lasers
- Mycobacteria, Atypical
- Myopia
- Postoperative Complications
- Retrospective Studies
- surgery
- transplantation
Other ID:
UI: 102269853
From Meeting Abstracts