Brief report
Aspergillus flavus keratitis after laser in situ keratomileusis

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Abstract

PURPOSE: To report a case of fungal keratitis caused by Aspergillus flavus after laser in situ keratomileusis surgery.

METHODS: Case report. A 24-year-old woman developed pain, redness, decreased vision, and an infiltrate posterior to the corneal flap in her right eye 3 days after laser in situ keratomileusis. On referral, approximately 3 weeks after laser in situ keratomileusis, examination of the right eye revealed light perception vision, a large full-thickness corneal infiltrate, and hypopyon. Corneal scrapings were taken for direct microscopic examination and culture.

RESULTS: Corneal scraping revealed the presence of fungal filaments in smears and in culture. The fungus was identified as A. flavus. Intensive topical natamycin and systemic ketoconazole therapy was initiated. Despite intensive medical treatment, the infiltrate progressed and the patient was subjected to a therapeutic penetrating keratoplasty. There was no recurrence of infection after surgery. At last follow-up 4 months after surgery, the eye was quiet with graft edema.

CONCLUSION: Fungal keratitis is a rare complication of laser in situ keratomileusis surgery. In a case that does not respond to medical treatment, early surgical intervention must be considered.

Section snippets

Case report

A 24-year-old woman underwent laser in situ keratomileusis surgery in both eyes on July 21, 1999. According to the referring doctor, vision was 20/20 in right eye on the first postoperative day. On the third day after surgery, she developed symptoms of pain, redness, watering, and decreased vision in the right eye. An infiltrate was noted posterior to the corneal flap. Considering this at first to be sterile infiltrate, the patient was given topical steroids every hour and systemic steroids.

Discussion

Perez Santonja and associates1 reported the first case of corneal infection after laser in situ keratomileusis surgery, which was caused by Nocardia asteroides.1 Subsequently, various authors reported isolated cases of bacterial keratitis after laser in situ keratomileusis surgery; the infections were caused by Mycobacterium chelonae,2Streptococcus pneumoniae,3Streptococcus viridans,4 and Staphylococcus aureus.5 We report this case of fungal keratitis caused by A. flavus to highlight the

References (5)

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    Nocardial keratitis after laser in situ keratomileusis

    J Refract Surg

    (1997)
  • V. Reviglio et al.

    Mycobacterium chelonae keratitis following laser insitu keratomileusis

    J Refract Surg

    (1998)
There are more references available in the full text version of this article.

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