title: Corneal ulceration in a LASIK patient due to vitamin a deficiency after bariatric surgery.
abstract: OBJECTIVE
  To review the case of a 41-year-old woman who underwent bariatric surgery in 2000. She subsequently underwent laser in situ keratomileusis (LASIK) surgery in 2008 and complained of dry eye since the LASIK surgery. In November 2010, she was diagnosed with a corneal melt and was treated with aggressive lubrication, followed by eventual amniotic membrane placement and a tarsorrhaphy. She then presented for consultation at the Bascom Palmer Eye Institute when she developed a corneal infiltrate. She was diagnosed with fungal keratitis with corneal xerosis. At that time, vitamin A levels were measured and were less than 2 μ/dL. The patient admitted noncompliance with nutritional supplements.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  The patient was treated with aggressive lubrication and natamycin. Vitamin supplements were restarted, and the patient experienced dramatic improvement in symptoms with resolution of the infection. A central corneal scar with corneal thinning remains. The patient underwent a penetrating keratoplasty for visual rehabilitation.
  
  
  CONCLUSIONS
  Patient education with emphasis on compliance with nutritional supplements is essential after bariatric surgery. Consider vitamin A deficiency in the differential diagnosis of dry eye after LASIK surgery.
authors.affiliation: Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA. kdonaldson@med.miami.edu
authors.forename: Kendall E
authors.initials: KE
authors.lastname: Donaldson
authors.forename: Jane
authors.initials: J
authors.lastname: Fishler
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001203:Ascomycota / Q000302:isolation & purification*; D050110:Bariatric Surgery / Q000009:adverse effects*; D003320:Corneal Ulcer / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007638:Keratoconjunctivitis Sicca / Q000209:etiology / Q000601:surgery; D020731:Keratomileusis, Laser In Situ; D015948:Keratoplasty, Penetrating; D009181:Mycoses / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D014792:Visual Acuity; D014801:Vitamin A / Q000097:blood / Q000627:therapeutic use; D014802:Vitamin A Deficiency / Q000209:etiology*
chemical_list: D000935:Antifungal Agents; D014801:Vitamin A