[Aspergillus fumigatus keratitis after laser in situ keratomileusis]

ABSTRACT

To report a case of unilateral Aspergillus fumigatus interface keratitis after laser in situ keratomileusis [LASIK]. A 22-year-old woman developed corneal infiltrates located at the flap- stroma interface in her left eye 48 hours after myopic LASIK. The infiltration progressed despite administration of topical fortified antibiotics therefore, the flap was lifted and irrigated with antibiotic solution. Six days after LASIK, visual acuity was counting fingers at 30 cm and a large full-thickness corneal infiltrate was located at the flap-stroma interface. On scanning confocal microscopy, fungal hyphae were observed as high-contrast filaments. The LASIK flap was amputated. Corneal scraping revealed fungal filaments in smears and culture. The fungus was identified as Aspergillus fumigatus. Fortified antibiotic drops were discontinued and intensive topical natamycin and systemic ketoconazole were initiated which controlled the keratitis. Two months after surgery the eye was quiet and vision improved to 20/200. Interface fungal infection after LASIK is a potentially vision-threatening complication. Early lifting of the flap, fungal culture and aggressive antifungal treatment are required to treat this complication. Confocal microscopy may be a fast and safe diagnostic tool in determining the presence of fungal hyphae in vivo within the human cornea