title: Post-laser in situ keratomileusis interface fungal keratitis.
abstract: OBJECTIVE
  To report outcomes of post-laser in situ keratomileusis (LASIK) interface filamentous fungal keratitis.
  
  
  METHODS
  This retrospective interventional case series included 6 eyes of 5 patients with microbiologically proven post-LASIK interface fungal keratitis from August 2008 to August 2013. Patients presenting with concurrent bacterial/viral keratitis, systemic illness, prior ocular pathology, or those without a minimum follow-up of 3 months were excluded. Every case underwent microbiological scrapings from residual bed and undersurface of the flap after flap lift at presentation followed by voriconazole interface wash. Flap amputation was performed when required. The outcome measure was complete resolution of infection.
  
  
  RESULTS
  The mean age was 24 ± 3.1 years. The male:female ratio was 4:1. The mean interval between LASIK and symptom onset was 4.16 ± 2 days; and the mean interval between symptom onset and patient referral was 3.16 ± 1.16 days. Interface scrapings showed filamentous fungal filaments in KOH wet mount. The culture grew Aspergillus in case 1 and case 5. Infiltrated LASIK flap needed to be amputated in 4 eyes of 3 patients. Voriconazole wash (100 μg/mL) of the stromal bed was performed in all cases. A positive response to therapy with resolution of infection was seen in all cases at a mean of 6.5 ± 4.6 days. No intraoperative or postoperative complications after interface scraping or voriconazole wash were observed. The final best-corrected visual acuity ranged from 20/20 to 20/80 at a mean follow-up of 9.1 ± 6.5 months.
  
  
  CONCLUSIONS
  Post-LASIK interface fungal filamentous keratitis can present early and gives good outcomes with early microbiological diagnosis and appropriate management. Voriconazole is an efficient and probably safe adjunct in the armamentarium of corneal surgeons to treat such cases.
authors.affiliation: *Cornea and Anterior Segment Services, Sanjivni Eye Care, Ambala, India; †DrishtiCONE eye care, Delhi, India; ‡Vitreoretina Services, Sanjivni Eye Care, Ambala, India; and §Clinical Trial Center, Dr Paul Dubord Chair in Cornea, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Mittal
authors.forename: Rajat
authors.initials: R
authors.lastname: Jain
authors.forename: Ruchi
authors.initials: R
authors.lastname: Mittal
authors.forename: Virender S
authors.initials: VS
authors.lastname: Sangwan
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D001231:Aspergillus flavus / Q000302:isolation & purification; D001234:Aspergillus niger / Q000302:isolation & purification; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000382:microbiology; D065819:Voriconazole / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole