Aspergillus flavus keratitis after laser in situ keratomileusis.
OBJECTIVE
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.


CONCLUSIONS
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.
Sridhar
M S
MS
Cornea Service, Hyderabad, India. mss@lvpeye.stph.net
Garg
P
P
Bansal
A K
AK
Gopinathan
U
U
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D001231:Aspergillus flavus / Q000302:isolation & purification*; D003315:Cornea / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D005260:Female; D006801:Humans; D007634:Keratitis / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D015948:Keratoplasty, Penetrating
D000935:Antifungal Agents