Non-tubercular mycobacterial keratitis – A case report

A 66-year-old woman presented with recurrent redness in the right eye after tapering of topical steroid two months post-uncomplicated cataract surgery. Each time she recovered well with a short course of topical steroid. At the fifth postoperative month, she developed cystoid macular edema, which resolved with subtenon Triamcinolone Acetonide after six weeks. But within one month, she presented with the main phacoemulsification tunnel infiltrate, which did not respond to medical therapy, and a patch graft was done. A sample from the patch graft revealed the organism to be a non-tubercular mycobacterium. Within 2 weeks, the infiltrate recurred in the patch graft and continued to worsen, with the development of a hypopyon despite medical management. Therapeutic penetrating keratoplasty was done, and she recovered 6/24, N-10 best corrected visual acuity in the right eye after 6 months. This case report highlights the fastidious nature of non-tubercular mycobacteria and the requirement for multiple surgical procedures to salvage the vision.