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Published on: July 6, 2015
Case Series of Perforated Keratomycosis after Laser-Assisted In Situ Keratomileusis
Taher Eleiwa1,2, Eyup Ozcan1,3, Samar Abdelrahman4
1Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.
Background:
Fungal keratitis is an extremely rare complication of laser vision correction resulting in poor visual outcomes. Amniotic membrane transplantation should be kept in mind in eyes with corneal perforation prior to penetrating keratoplasty.
Aim:
To assess the outcomes of multilayered fresh amniotic membrane transplantation (MLF-AMT) in patients with severe keratomycosis after laser-assisted in situ keratomileusis (LASIK). Study design. Hospital-based prospective interventional case series.
Methods:
Five eyes of 5 patients were included in the study. All cases underwent microbiological scrapings from residual bed and intrastromal injections of amphotericin (50 mcg/mL), with flap amputation if needed, followed by topical 5% natamycin and 0.15% amphotericin. MLF-AMT was performed after corneal perforation. Later, penetrating keratoplasty (PK) was performed when corneal opacity compromised visual acuity. The outcome measures were complete resolution of infection, corneal graft survival, and best-corrected visual acuity (BCVA).
Results:
The mean age of patients was 22 ± 1.2 years with 4/5 (80%) were females. The mean interval between LASIK and symptom onset was 8.8 ± 1 day, and the mean interval between symptom onset and referral was 14 ± 1.4 days. Potassium hydroxide (KOH) smears showed filamentous fungi, and Sabouraud's medium grew Aspergillus in all cases. Melted flaps were amputated in 4 (80%) cases. MLF-AMT was performed in all cases due to corneal perforation after a mean time of 12.4 ± 1.2 days of antifungals. In all cases, complete resolution of infection was seen 26 ± 1.8 days after MLF-AMT, and optical PK was done at a mean of 2.4 months later. No postoperative complications after MLF-AMT or PK were observed, with a 0% incidence of corneal graft rejection, and a final BCVA ranged from 20/20 to 20/80 after a mean follow-up of 14 ± 1.1 months.
Conclusion:
MLF-AMT is a safe and valid option to manage corneal perforation during keratmycosis treatment to avoid emergency therapeutic keratoplasty.
Insights
Multilayered fresh amniotic membrane transplantation (MLF-AMT) effectively treats fungal keratitis after laser vision correction. This procedure helps avoid emergency corneal transplants, preserving vision in severe cases.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Infectious Diseases
Background:
- Fungal keratitis is a rare but severe complication following laser vision correction procedures like LASIK.
- Corneal perforation in fungal keratitis cases often necessitates aggressive treatment to prevent vision loss.
Observation:
- This study evaluated multilayered fresh amniotic membrane transplantation (MLF-AMT) in five patients with severe fungal keratitis post-LASIK.
- All patients presented with corneal perforation and were treated with antifungals, flap amputation, and MLF-AMT.
Findings:
- MLF-AMT was successfully performed in all cases, leading to complete infection resolution within 26 days.
- Optical penetrating keratoplasty was performed later when needed, with no graft rejection or postoperative complications observed.
- Final best-corrected visual acuity ranged from 20/20 to 20/80 after a mean follow-up of 14 months.
Implications:
- MLF-AMT offers a safe and effective alternative to immediate therapeutic keratoplasty for managing corneal perforations in fungal keratitis.
- This approach can help preserve the native cornea and improve visual outcomes in patients with post-LASIK fungal keratitis.
