title: Combined treatment with flap amputation, phototherapeutic keratectomy, and collagen crosslinking in severe intractable post-LASIK atypical mycobacterial infection with corneal melt.
abstract: A 23-year-old woman was referred for management of intractable post-laser in situ keratomileusis (LASIK) keratitis due to atypical mycobacteria in the left eye. Corrected distance visual acuity was 20/20 in the right eye and counting fingers at 3 meters in the left eye. Slitlamp examination revealed multiple infiltrates in the flap interface and severe corneal stromal melting with thinning. Despite maximum antibiotic therapy for 7 days, the keratitis continued to worsen. A penetrating keratoplasty (PKP) was scheduled. While waiting for a corneal graft, corneal collagen crosslinking (CXL) with riboflavin and ultraviolet-A was proposed as an alternative treatment. Flap amputation and limited phototherapeutic keratotomy (PTK) (10 μm) were also performed. One week postoperatively, all infiltrates and stromal edema had resolved. At 3 months, the uncorrected distance visual acuity improved to 20/35. Corneal crosslinking after flap amputation and limited PTK was an effective treatment for severe intractable post-LASIK keratitis with corneal melting and obviated PKP.
authors.affiliation: Institute of Vision and Optics, University of Crete, Crete, Greece. kymionis@med.uoc.gr
authors.forename: George D
authors.initials: GD
authors.lastname: Kymionis
authors.forename: Vardhaman P
authors.initials: VP
authors.lastname: Kankariya
authors.forename: Georgios A
authors.initials: GA
authors.lastname: Kontadakis
mesh_terms: D000671:Amputation, Surgical; D003094:Collagen / Q000378:metabolism*; D003131:Combined Modality Therapy; D003319:Corneal Stroma / Q000378:metabolism / Q000601:surgery; D003320:Corneal Ulcer / Q000382:microbiology / Q000628:therapy; D003432:Cross-Linking Reagents / Q000378:metabolism*; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D018903:Photorefractive Keratectomy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011183:Postoperative Complications; D012256:Riboflavin / Q000627:therapeutic use; D013524:Surgical Flaps / Q000473:pathology; D014466:Ultraviolet Rays; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin