Post-laser in situ keratomileusis (LASIK) interface filamentous fungal keratitis: clinical course and outcomes

Session Details

Session Title: Investigations and Complications Management

Session Date/Time: Tuesday 13/09/2016 | 13:30-15:15

Paper Time: 15:02

Venue: Hall C3

First Author: : V.Mittal INDIA

Co Author(s): :    R. Mittal   R. Jain                 

Abstract Details

Purpose:

To report outcomes of post-laser in situ keratomileusis (LASIK) interface filamentous fungal keratitis.

Setting:

Cornea and Anterior Segment services, Sanjivni Eye Care, Ambala, Haryana, India`

Methods:

This retrospective interventional case series included 8 eyes of 7 patients with microbiologically proven post-LASIK interface fungal keratitis from August 2008 to March 2016. Patients presenting with concurrent bacterial/viral keratitis, systemic illness, prior ocular pathology, or those without a minimum follow-up of 3 months were excluded. Every case underwent microbiological scrapings from residual bed and undersurface of the flap after flap lift at presentation followed by voriconazole interface wash. Flap amputation was performed when required. The outcome measure was complete resolution of infection.

Results:

Mean age- 24 years; Male:female- 5:2; Mean interval between LASIK and symptom onset was 5.4 days; and the mean interval between symptom onset and patient referral was 7.7 days. Microbiological analysis- Wet KOH mount showed filamentous fungus in all eyes and culture grew Aspergillus in 4 eyes. LASIK flap amputation was done in 4 eyes (3 patients). Voriconazole wash (100 μg/mL) of the stromal bed was performed in all cases followed by topical natamycin and voriconazole therapy. Infection resolved in all eyes (mean 4.4 weeks). The final BCVA ranged from 20/20 to 20/80 at a mean follow-up of 8 months.

Conclusions:

Post-LASIK interface fungal filamentous keratitis can present early and gives good outcomes with early microbiological diagnosis and appropriate management. Voriconazole is an efficient and safe adjunct in the armamentarium of corneal surgeons to treat such cases.

Financial Disclosure:

NONE