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Interface fungal infection after laser in situ keratomileusis presenting as diffuse lamellar keratitis. A
Qun Peng1, Mike P Holzer, Peter H Kaufer
1Center for Research on Ocular Therapeutics and Biodevices, Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, 167 Ashley Avenue, Charleston, SC 19425-5536, USA.
Purpose:
To report clinicopathological analyses of 3 cases of interface fungal infection following laser in situ keratomileusis (LASIK) and diffuse lamellar keratitis (DLK).
Setting:
Center for Research on Ocular Therapeutics and Biodevices and Arthur and Holly Magill Research Center for Vision Correction, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA.
Methods:
Clinicopathological analysis of 5 eyes of 3 patients who developed culture-proven interface fungal infection after LASIK was performed. Detailed pathological analysis of the amputated flap from 1 case included light, scanning, and transmission electron microscopy.
Results:
Culture and pathological analysis revealed Candida albicans in all 3 cases. Common links among the cases were early onset of DLK following intensive corticosteroid and antibiotic treatment and later onset of interface fungal infection. All cases resolved, and good visual acuity was restored after medical treatment with antifungal agents.
Conclusions:
Interface fungal infection after LASIK can be sight-threatening. Early lifting of the flap, fungal culture, and aggressive antifungal treatment are required to treat this complication and avoid deleterious sequelae.
Insights
Interface fungal infections following laser in situ keratomileusis (LASIK) can be serious. Early diagnosis and antifungal treatment are crucial for preserving vision after LASIK surgery.
Area of Science:
- Ophthalmology
- Mycology
- Surgical Complications
Background:
- Laser in situ keratomileusis (LASIK) is a common refractive surgery.
- Diffuse lamellar keratitis (DLK) and interface fungal infections are potential complications.
Observation:
- This study analyzed 3 cases of interface fungal infection post-LASIK.
- All cases presented with early diffuse lamellar keratitis (DLK) after corticosteroid use.
- Candida albicans was identified as the causative agent in all instances.
Findings:
- Interface fungal infection following LASIK can lead to significant vision loss.
- Early DLK, intensive corticosteroid use, and subsequent fungal infection were observed.
- Prompt medical intervention with antifungal agents led to resolution and visual recovery.
Implications:
- Early flap elevation, fungal culture, and aggressive antifungal therapy are critical for managing LASIK-associated fungal infections.
- Timely treatment is essential to prevent severe visual impairment.
- This highlights the importance of vigilance for fungal infections in post-LASIK patients with DLK.