Обновленные данные по диагностике и лечению микобактериального кератита

Atypical mycobacterial keratitis is a rare but clinically challenging form of infectious keratitis caused by a diverse group of nontuberculous mycobacteria (NTM).[¹,²,³] NTM are characterized by speed of growth, where Runyon Group I–III include the slow-growing forms (17% of ocular NTM infections) and the more prevalent, fast-growing Group IV (e.g., Mycobacterium fortuitum, Mycobacterium abscessus, and Mycobacterium chelonae) (83% of ocular NTM infections).[⁴] The incidence of NTM keratitis depends on geographic location, but overall is low, accounting for 1.1%–7.9% of all causes of infectious keratitis at two large referral centers.[⁵] Exposure to organic material and corneal manipulation during surgery are commonly associated with the introduction of NTM bacteria into the corneal stroma. The diversity of organisms results in nonspecific findings, allowing the infection to masquerade as another type of keratitis and often delaying diagnosis and treatment. Difficulty culturing and antibiotic resistance further complicate the management of this disease. This review describes the current landscape in management of this challenging form of infectious keratitis, from diagnosis to medical, laser-based, and surgical interventions.