Interactive Case Reports

Fungal interface keratitis after laser in situ keratomileusis (LASIK)

Case Report Details

First Author: R.Vieira PORTUGAL

Co Author(s):    P. Baptista   C. Abreu   S. Monteiro   C. Brochado           

Abstract Details

Purpose:

To report a rare case of post-laser in situ keratomileusis (LASIK) interface filamentous fungal keratitis and its successful management.

Setting:

Department of Ophthalmology of a tertiary referral center in Oporto, Portugal - Centro Hospitalar Universitário do Porto.

Report of Case:

A healthy 30-year-old woman underwent uncomplicated bilateral LASIK surgery for myopia in a private center and was medicated with topical ofloxacin, dexametasone and artificial tears. Two weeks after surgery she complained of blurred vision, photofobia and discomfort on her left eye (LE). In the following days she was observed by her ophthalmologist who added to her medication oral steroids, topical acyclovir and clotrimazole. She was also submitted to a subconjunctival steroid injection. Due to worsening of symptoms, the patient was referred to our department a few days later. A complete medical history was carried out, highlighting a trip to a natural park to jogging 5 days after the surgery. Uncorrected distance visual acuity (UCVA) of the LE was 20/100. Slit-lamp examination revealed diffuse corneal edema, a central and irregular white nodular infiltrate with corneal ulceration and the presence of numerous inflammatory cells on flap’s interface. Corneal scrapings were taken from ulcer, and filamentous fungus were identified by microscopic examination. She started treatment with fortified voriconazole (1%) drops hourly, moxifloxacin 5 times daily and topical steroids once daily. Two weeks later, a Scopulariopsis brevicaulis species was isolated on culture. The infiltrate resolved with mild scarring after 6 weeks of intensive treatment. At the end of follow-up the UCVA was improved to 20/20.

Conclusion/Take Home Message:

Despite being an extremely rare complication, post-LASIK interface fungal filamentous keratitis is a severe complication that can lead to poor visual outcomes. Fortunately, this report shows that an early diagnostic suspicion, combined with early microbiological diagnosis and appropriate management can give good outcomes. The isolated fungi (Scopulariopsis brevicaulis spp) are common soil saprophytes that can be found on a wide variety of substrates. Taking into account the information about the jogging a few days after surgery, the authors hypothesize that this may have been the cause of the infection. Furthermore, according to our report, voriconazole seems to be effective and safe to treat such cases, which meets published literature.

Financial Disclosure:

None