title: Delayed-onset multifocal polymicrobial keratitis after laser in situ keratomileusis.
abstract: We report a case of mixed Aspergillus fumigatus and coagulase-negative Staphylococcus stromal keratitis in a 43-year-old man who developed discomfort and swelling in his right eye 20 days after uneventful bilateral laser in situ keratomileusis (LASIK). Clinical examination revealed 2 distinct corneal infiltrates beneath the LASIK flap. Corneal scrapings were taken for microscopic examination and culture. Both infiltrates initially improved on topical antibiotic therapy, but over the next 18 days, 1 infiltrate worsened and repeat cultures were performed, which demonstrated A fumigatus. Natamycin 5% and amphotericin 0.1% were started and continued for 8 weeks with resolution of the infiltrate and return of the best corrected visual acuity. Delayed-onset multifocal keratitis is a rare complication of LASIK. Fungal entities should be considered in the differential diagnosis.
authors.affiliation: Department of Ophthalmology, The New York Eye and Ear Infirmary, New York, New York, USA. ritterband@msn.com
authors.forename: David
authors.initials: D
authors.lastname: Ritterband
authors.forename: James
authors.initials: J
authors.lastname: Kelly
authors.forename: Tara
authors.initials: T
authors.lastname: McNamara
authors.forename: Michael
authors.initials: M
authors.lastname: Kresloff
authors.forename: Richard
authors.initials: R
authors.lastname: Koplin
authors.forename: John
authors.initials: J
authors.lastname: Seedor
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000209:etiology*; D001232:Aspergillus fumigatus / Q000302:isolation & purification*; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000209:etiology*; D015821:Eye Infections, Fungal / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007634:Keratitis / Q000188:drug therapy / Q000382:microbiology*; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008297:Male; D010866:Natamycin / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology*; D013210:Staphylococcus / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D000666:Amphotericin B; D010866:Natamycin