Eyeworld

89 EW CORNEA October 2018 Editors' note: Dr. Hua has no financial interests related to his comments. Contact information Hua: oogziekten@uzleuven.be At this point, Dr. Hua received notice from his hospital's microbiol- ogy department that the organism in question was Mycobacterium che- lonae, a nontuberculous mycobacte- rium classified as rapidly growing. M. chelonae grows best at 30–32 degrees centigrade and may have a long incubation period. Aside from its known association with skin and soft tissue infections, this organism causes catheter and post-surgical in- fections after implants, transplants, and injections. 3 By the second postoperative month, the patient's UCVA was 0.4 logMAR. After the first month on the prescribed treatment regimen, Dr. Hua noted the beginnings of changes in the appearance of the lesions in the graft/stromal inter- face. "We saw no new infiltrates, but what was changing was the color of the lesions. They turned bicolor with the central portion becoming whiter and the edges of the lesions becoming sharper. The size of the infiltrates was the same. We kept the patient on amikacin 6x/day, moxi- floxacin 4x/day, tobramycin/dexa- methasone 1x/day, and clarithromy- cin per os 500 mg 2x/day. By month 3, UCVA was slightly improved at 0.6 logMAR, but by the time we reached 4 months of treatment, the patient had become irritated at the medication regimen and oral antibi- otics," Dr. Hua said. Dr. Hua observed that the lesions underwent further chang- es between the fourth and fifth months of treatment (day 137), with the evolution of the lesions from creamy to whiter and sharper over time. Day 143: Repeat DMEK surgery A repeat DMEK was performed on day 143. The graft exchange was carried out in the operating room, under air. "With a scraper we took out the first DMEK graft," Dr. Hua explained. "The lesions, however, did not come out with the graft; they were still adhering to the stroma. A microbiologist was on standby to check the specimen by culture and staining. With the scrap- er we manually had to take out the infiltrates and rinsed with balanced salt solution." The microbiology report showed the presence of M. chelonae DNA in the infiltrates. The culture was still positive for living myco- bacteria in the eye. The staining was also positive for the organism. After the DMEK exchange, the patient's UCVA was 0.7. In the first 2 weeks after surgery, he was not given corticosteroid eye drops. He received systemic antibiotics in addition to the previous regimen, which was maintained. Dr. Hua was able to examine the patient shortly before the ESCRS Winter Meeting and was satisfied with the patient's progress. Antibiotics were stopped by month 5. He said that he would be checking the patient again to exclude any recurrences. EW References 1. De Groote MA, Huitt G. Infections due to rapidly growing mycobacteria. Clin Infect Dis. 2006;42:1756–63. 2. Ryu YJ, et al. Diagnosis and treatment of nontuberculous mycobacterial lung disease: clinicians' perspectives. Tuberc Respir Dis (Seoul). 2016;79:74–84. 3. Akram SM, Bhimji SS. Mycobacterium chelonae. StatPearls. May 16, 2017. Relief in sight Katena — Your complete resource for amniotic membrane procedure products: Single use speculums Single use spears Forceps Dehydrated amniotic membrane for in-office procedures ® www.katena.com • 800.225.1195 KB-Adv-053117a-Rev 0 Effective • Retains the growth factors found in natural amniotic membrane 1 • Retains more of these growth factors than other dehydrated amniotic membrane product 1 Well-tolerated • No tape tarsorrhaphy required • Minimized foreign body sensation Simple in-office procedure • Easily applied to a dry cornea • Covered with a bandage contact lens Convenient • 5 year shelf life • Stored at room temperature • No freezer or special shipping & handling required 100,000+ eyes treated Applications • Conditions associated with excessive dry eye • Recurrent corneal erosions • Corneal ulcers • Chemical and thermal burns • Neurotrophic ulcers The Purion® Process • The gold standard in dehydrated amniotic membrane preservation • Safely and gently cleans and preserves the amniotic membrane 1 Koob TJ, Lim JJ, Zabek N, Massee M. 2014. Cytokines in single layer amnion allografts compared to multilayer amnion/chorion allografts for wound healing. J Biomed Mater Res Part B 2014:00B:000-000 Atypical continued from page 87

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