Post LASIK Infections PDF Print E-mail

Live virus survives excimer laser ablation

Opthalmology 1999 Aug;106(8):1498-9

Taravella MJ, Weinberg A, May M, Stepp P.

Department of Ophthalmology, University of Colorado Health Sciences Center, Denver, USA. Michael.Taravella@uchsc.edu

OBJECTIVES: To determine whether live virus can withstand excimer laser ablation and pose a possible health hazard to medical personnel.

DESIGN: Experimental study.

METHODS: Fibroblasts infected with oral polio vaccine virus were ablated with an excimer laser. The plume was collected using a smoke evacuator and bubbled through viral culture media.

MAIN OUTCOME MEASURES: The inlet tube from the smoke evacuator was swabbed and cultured for virus. Liquid from the bubble trap was also cultured.

RESULTS: Live virus was shown in the material trapped from the laser plume.

CONCLUSIONS: Oral polio vaccine virus can survive excimer laser ablation. Whether other more clinically relevant viruses, such as human immunodeficiency virus, can withstand ablation and remain infectious remains to be determined.

Aerosolization of infectious virus by excimer laser

American Journal of Ophthalmology 1997 March, 123(3):297-302

Moreira LB, Sanchez D, Trousdale MD, Stevenson D, Yarber F, McDonnell PJ. Doheny Eye Institute, Los Angeles, CA 90033, USA.

PURPOSE: To determine the potential for aerosolization of infectious virus present within the tear film during excimer laser photoablation of the cornea.

METHODS: Cell monolayers infected with herpes simplex virus or adenovirus, simulating virus-infected corneas, were ablated with the 193-nm excimer laser. Adjacent dishes containing noninfected cell monolayers were subsequently assayed for viral infection.

RESULTS: Viral spread to sentinel dishes occurred with both herpes simplex and adenovirus. The titer of virus present in the infected cell monolayers influenced the likelihood of spread to adjacent dishes. The presence of a vacuum aspiration system appeared to influence the direction of virus spread, with dishes located in the direction of the vacuum most likely to contain virus.

CONCLUSIONS: The potential for aerosolization of infectious virus exists with photoablation using a large-diameter excimer laser beam. Our experimental design, however, does not prove that spread of infectious virus is likely to occur in the clinical setting. Appropriate measures should be taken to reduce the possibility of the spread of virus from the patient to the surgeon, other medical staff, or other patients.

PMID: 9063238 [PubMed - indexed for MEDLINE]

Epidemic and sporadic cases of nontuberculous mycobacterial keratitis associated with LASIK

American Journal of Ophthalmology Volume 135, Issue 2 ,

Kevin L. Winthrop MD , , a, Ellen B. Steinberg MD, MPHa, c, Gary Holmes MDd, Marion A., Kainer MBBS, MPHa, S. B. Werner MD, MPHb, Andrea Winquist MDa, b and Duc J. Vugia MD, MPHb

a) Epidemiology Program Office (K.L.W., E.B.S., M.A.K., A.W.), Centers for Disease Control and Prevention, Atlanta, Georgia, USA b) California Department of Health Services (S.B.W., A.W., D.J.V), Berkeley, California, USA c) Division of Public Health (E.B.S.), Georgia Department of Human Resources, Atlanta, Georgia, USA d) Scott and White Clinic (G.H.), Temple, Texas, USA - Accepted 30 August 2002. ; Available online 28 January 2003.

Purpose: To report national case-finding results for nontuberculous mycobacterial keratitis and describe its association with laser in situ keratomileusis (LASIK).

Design: Enhanced passive disease reporting.

Methods: In April 2001, we investigated a California cluster of Myco bacterium chelonae keratitis associated with hyperopic LASIK using a contact lens mask. To identify other possibly related cases, the American Academy of Ophthalmology e-mailed its members asking them to report recent cases of nontuberculous mycobacterial keratitis to the Centers for Disease Control and Prevention.

Results: Forty-three additional cases of keratitis were reported (onsets between August 2000 and June 2001). Of these, 31 occurred as part of two unrelated LASIK- associated outbreaks. The 12 other reported cases occurred in sporadic fashion. Of the latter cases, 4 were associated with LASIK surgery. None of the reported cases were related to the M. chelonae cluster in California.

Conclusions: Laser in situ keratomileusis-associated keratitis with nontuberculous mycobacteria may be more common than previously known.