EyeRounds Online Atlas of Ophthalmology
Contributor: John Chen, MD, PhD, The University of Iowa
Photographer: Stefani Karakas, CRA
75-year-old male with mycobacterial keratitis within a penetrating keratoplasty graft. Note the stromal crystalline infiltrate. Mycobacterial keratitis presents with an epithelial defect with an underling stromal infiltrate, which can be dense, ring-like, or crystalline as in our case. Treatment generally consists of frequent topical clarithromycin and a 4th generation fluoroquinolone. Despite aggressive treatment, mycobacterial keratitis is often indolent and recalcitrant to treatment resulting in corneal scarring and a poor visual outcome.
Our patient's corneal cultures grew Mycobacterium chelonae, the most common organism implicated in nontuberculous mycobacterial keratitis. The keratitis was unresponsive to medical management and ended up requiring a repeat penetrating keratoplasty.
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