Table 2 An overview of previous cases of keratitis caused by Mycobacterium chelonae in Europe

56-year-old woman

painful left eye, corneal ulcer, hard contact lenses for 18 years

microscopy and culture from corneal biopsy/about 8 weeks

AT neomycin 0.5%/hydrocortisone 1.5%, chloramphenicol 0.5%, betamethasone 0.1%/neomycin 0.5%, gentamicin

0.3% and methicillin 2%, prednisolone 0.3%, acyclovir 3% 5x/day, miconazole 1% 2-hourly and atropine 1%, amikacin

2.5% hourly, dexamethasone

0.1% hourly/day, 2-hourly/night with atropine 1%

the patient was then admitted for intensive AT therapy

with imipenem 0.5% hourly/day, 2-hourly/

night, ciprofloxacin 0.2% hourly/day and 2-hourly/

night, erythromycin 5x/day, atropine 1% 2x a day and

dexamethasone 0.1% / 11 months

necessary to perform penetrating keratoplasty, two years later graft remained clear, visual acuity 6/12

Broadway et al. 1994

26-year-old man

keratitis 1 month after myopic photorefractive keratectomy (briefly after long sea swimming)

microscopy and culture from corneal scrapings/2weeks

AT tobramycin

sodium, AT diclofenac

sodium were applied topically 4x a day, two days later dexamethasone sodium 4x a day

eyedrops of ciprofloxacin sodium, 0.3 mg/mL/and amikacin sodium, 10 mg/mL, cyclopentolate

hydrochloride and

PO clarithromycin sodium, 500 mg, 2x a day/one week

Then eyedrops of ciprofloxacin sodium, 0.3 mg/mL/and amikacin sodium/3 months

1 year postoperatively visual acuity 20/20, cornea had a grade 2 subepithelial haze

Brancato et al. 1997

Four, 56 to 64-year old women

all women developed keratitis after LASIK performed at the same time period with same surgeon

culture from corneal swabs and scrapes/1 week

Prednisone 60 mg a day, AT ciprofloxacin 0.3% + amikacin 50 mg/mL + clarithromycin 10 mg/mL, PO doxycycline 2 × 100 mg for all 4 patients / 6 weeks

AT ciprofloxacin 0.3% + amikacin 50 mg/mL + azithromycin 10 mg/mL, PO doxycycline 2 × 100 mg for 3 patients / 6 weeks

3 patients responded well on the therapy, fourth patient underwent additional surgery because of necrosis

Chandra et al. 2001

52-year-old woman

unilateral keratitis after LASIK

microscopy and PCR from conjunctival and corneal swabs/about 3 weeks

levofloxacin IV 500 mg 1x a day, AT ofloxacin 3x a day AT natamycin + ofloxacin and IV fluconazole

AT levofloxacin and amikacin, PO clarithromycin

despite antibiotic treatment, flap removal was necessary to control infection, visual acuity 0.2

Kohnen et al. 2003

45-year-old patient

perforating keratoplasty for alkali burn

culture of corneal biopsy/unknown

AT amphotericin B + ciprofloxacin + tobramycin + ceftazidime

PO clarithromycin 3 months, imipenem

poor response on antibiotic therapy, necessary to remove implant

Labalette et al. 2003

37-year-old man

unilateral keratitis after simultaneous LASIK

corneal tissue sample fungal filaments only microscopically, culture reveal M. chelonae, presence of M. chelonae from the beginning unclear/9 months

AT tobramycin 0.3% + amphotericin 0.5%, PO doxycycline 200 mg + prednisolone, topical 3 mg/mL gentamicin + 1 mg/mL betamethasone + and 1.8 mg/mL hyaluronic acid

AT amikacin, ciprofloxacin, PO clarithromycin / 10 months

10 months after lamellar keratoplasty and antibiotic therapy, graft remain clear

Pache et al. 2003

60-year-old woman

infectious keratitis of 3 months duration, medical history included long-standing rheumatoid arthritis treated with hydroxychloroquine and secondary ocular surface syndrome, for which she was treated with topical lubricants

acid-fast rods presented in corneal scraping, PCR positive for M. chelonae/3 months

cefazolin 50 mg/mL hourly + tobramycin 14 mg/mL hourly and homatropine 2% 2x a day. PO ciprofloxacin 750 mg + PO clarithromycin 500 mg 2x a day

PO ciprofloxacin 750 mg + PO clarithromycin 500 mg, 2x a day and AT erythromycin 10 mg/mL + ofloxacin 3 mg/mL á 2hrs / 10 months

corneal infiltrates resolved within 5 months, after 10 months ATB therapy terminated, there was deep central corneal scarring with some los of stroma, ocular examination within normal limits, BCVA 20/40, no recurrence in following months

Van Der Beek et al. 2008

33-year-old man

keratitis - photophobia and redness of right eye with blurred vision and white corneal interface 1 month after bilateral LASIK procedure

acid-fast rods in corneal scraping, culture M. chelonae, multi-drug resistant (resistant to amikacin and clarithromycin)/up to 2 weeks

AT ciprofloxacin and tobramycin, after ART revealing amikacin 0.1%, clarithromycin 1%, vancomycin 1%, moxifloxacin 0.3%, PO clarithromycin

AT linezolid 2 mg/mL / 6x a day/2 months

after 2 months detected only subtle leukoma, final visual acuity 20/30 OD, 20/40 OS

Dolz-Marco et al. 2012

71-year-old man

graft rejection after 8 months from tectonic keratoplasty complicated by painful left eye, detected white corneal infiltrate

second corneal scraping sample revealed M. chelonae/unknown

N/A

AT cefuroxime + amikacin + gentamicin, PO linezolid, 1 month

after 1 month of therapy, penetrating keratoplasty performed complicated by postoperative hyphema and recurrence of the endothelial

Chowdhury et al. 2016

76-year-old man

patient with Fuchs endothelial dystrophy developed infectious keratitis after DMEK (Descemet membrane endothelial keratoplasty)

culture of M. chelonae from the cornea bank, donor cornea transport medium and culture and PCR of M. chelonae from cornea graft/3 weeks

AT moxifloxacin

4x a day, tobramycin–dexamethasone 2x a day,

amikacin 8x a day, and PO clarithromycin 500 mg 2x

a day.

AT amikacin 8x a day, moxifloxacin 4x a day, PO clarithromycin 500 mg 2x a day, PO ciprofloxacin 500 mg 2x a day / 5 months

1 year after repeated DMEK, all precipitates resolved, no signs of active infection, visual acuity 20/25

Van Landeghem et al. 2019