Table 1 (supplementary). Summary of cases in which a fourth-generation fluoroquinolone was used in the treatment of an ocular surface infection by Mycobacterium chelonae. Antibiotics listed are topical formulations unless
otherwise specified.
Treatment
Case(s) Age/gender
Risk factor(s)
Diagnosis
No. 1
Pseudophakia,
neurotrophic
keratopathy
due to HZO,
chemotherapy
Keratitis,
endophthalmitis
68/male
Eye(s)
involved
Left
Corticosteroid
Exposure
Yes
Drug
combination
T, VC
Duration
Other intervention(s)
Result
Antibiotic
susceptibility
S: AM
Reference
NR
Gluing of perforated
Descemetocele, corneal scrapings
for culture
No significant improvement, growth of M. chelonae*
AM, MX,
CL(oral)
6 weeks
R: AM, CL
Dolz-Marco et al.¹³
Flap lift, corneal scrapings for
culture, irrigation with GT
Appearance of new satellite lesions, growth of M.
chelonae
Infection stabilized
Mild improvement followed by recurrent disease, growth
of M. chelonae
R: GT
(intermediate)
De la Cruz et al.¹⁴
R: GT, MX
No significant improvement
Therapeutic PK
Intravitreal CFA and VC
PPV, intravitreal AM, VC, and AMP
No. 1
No. 1
No. 1
No. 1
33/male
25/male
25/male
32/female
Bilateral LASIK
Bilateral LASIK
with right eye
enhancement
Bilateral LASIK
Bilateral LASIK
Bilateral
keratitis
Keratitis
Keratitis
Keratitis
Both
Right
Left
Right
NR
Yes
NR
GT, AM
<1 week
Flap re-lifted ,irrigation with GT,
reculture
Mild improvement followed by recurrent disease, growth
of M. chelonae
MX, CL
<3 weeks
Flap excision, irrigation with GT
Infection resolution
Infiltrates enlarged, appearance of new satellite lesions,
hypopyon, growth of M. chelonae
Gradual improvement of infiltrates, infection was still
active
No significant improvement, persistent epithelial defect
Infection resolution
Persistent epithelial defect, flap necrosis
S: AM, CL
R: LV
5 weeks
Flap lift, irrigation with AM and CL,
corneal scrapings for culture
Flap excision, irrigation with AM, CL
Growth of M. chelonae
S: AM, CL, CP
R: GT, MX
Yes
Yes
PPV, explantation of PCIOL and
intravitreal AM
Right flap lift and corneal scraping
for culture
AM, CL, LV,
CL(oral)
AM, CL
AM, CL, GT
AM, VC,
CL(oral)
8 weeks
4 months
2 weeks
Flap excision, repeat corneal
cultures
AM, CL,
CL(oral),
DX(oral)
No. 1
60/female
63/female
No. 1
Secondary
Sjogren's
syndrome and
associated dry
eye
History of TNF
antagonist
Keratitis
Keratitis
Left
Right
NR
Yes
AC inflammation 20 days post-PK
Immediate improvement followed by recurrent AC
inflammation 9 months post-PK
Improvement followed by recurrent AC inflammation and
vitritis 3 months post-PPV
Infection resolution
AM, CL, VC,
MX, CL(oral)
LZ
GT, CP
2 months
<1 week
CFO, T,
CP(oral),
CL(oral)
E, CP(oral),
CL(oral)
AM, CL(oral)
1 month
Venkateswaran et al.⁸
Hamam et al.¹⁸
Moshirfar et al.20
Infection stabilized
Allergic reaction to CFO
5 months
Infection stabilized
6 months
Mild improvement, persistent infiltrate
S: CP, CL
R: AM, T, DX, LZ
van der Beek et al.21
Not available
Present study
therapy for
RA, corneal
abrasion
No. 2
No. 3
63/female
70/female
Chemotherap
y, bilateral
HSV
keratouveitis
Pseudophakia
Keratitis,
bilateral
Conjunctivitis
Both
Right
AM, B,
CL(oral)
<5 months
CL(oral) weaned after 3 weeks of starting B; infiltrate
improved after 11 weeks of B
Yes
AM, CL(oral)
2 months
22 months
Yes
AM, B,
CL(oral)
T, DX
B
10 weeks
Worsened infiltrates bilaterally, AC inflammation in left
eye
Multiple recurrences with attempted antibiotic wean,
eventual resolution of infection
No improvement,
Growth of M. chelonae
Infection resolution
<3 weeks
Excisional biopsy of conjunctival
nodule for culture
S: T, CL, LZ
R: CP
S: T, LZ
R: CP
NR = not reported, S = susceptible to, R = resistant to, HZO = herpes zoster ophthalmicus, PK = penetrating keratoplasty, AC = anterior chamber, PPV= pars plana vitrectomy, PCIOL = posterior chamber intraocular lens, LASIK = laser in
situ keratomileusis, TNF = tumor necrosis factor, RA = rheumatoid arthritis.
*Initial report of M. abscessus that was later revealed to be M. chelonae.
AM = amikacin, B = besifloxacin, CFA = ceftazidime, CFO = cefazolin, CP = ciprofloxacin, CL = clarithromycin, DX = doxycycline, E = erythromycin, GT = gatifloxacin, LV = levofloxacin, LZ = linezolid, MX = moxifloxacin, T
= tobramycin, VC = vancomycin