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Deze abstract is toegekend aan sessie AOB Free Papers 1
Type presentatieOral presentation
TitelLASIK Flap Amputation Following Fulminant Postoperative Keratitis
DoelTo report a rare case of presumed fungal keratitis requiring LASIK flap amputation.
MethodesA 30-year-old patient underwent uneventful femto-LASIK. On day 1, small infiltrates were diagnosed as sterile inflammation and treated with topical tobramycin/dexamethasone. After initial improvement, the condition worsened and the same therapy was intensified. At referral, fulminant keratitis with mid-to-deep stromal involvement, diffuse corneal edema, and anterior chamber reaction (3+) was noted. CDVA was Snellen 6/48.
ResultatenIntensive fortified antibiotics, cycloplegia, systemic antivirals, and doxycycline were initiated, but no improvement occurred. With flap breakdown and progression, the differential shifted to fungal or acanthamoeba keratitis; topical PHMB, chlorhexidine, and amphotericin B (0.15%) were added. Due to central flap necrosis and expanding infiltrates, LASIK flap amputation with intrastromal voriconazole injection (50 µg / 0.1 mL) was performed. Postoperatively, the patient was put on a regimen of topical PHMB, amphotericine B (0.15%), ofloxacin, and autologous serum drops, as well as systemic treatment with voriconazole, doxycycline, and vitamin C. Gradual regression of infiltrates and eventual closure of the epithelial defect occurred after five weeks. Corticosteroids were cautiously reintroduced after stabilization. At last follow-up, the cornea was quiet with central scarring and CDVA was Snellen 6/15.
ConclusiePresumed fungal keratitis after LASIK may masquerade as sterile inflammation and progress fulminantly. Early recognition, aggressive therapy escalation, and timely flap amputation with intrastromal antifungal injection are critical to preserve the eye.
BelangenverstrengelingNee
Auteurs 1
InitialenA
NaamSHERVINE
InstituutUZ Brussel
StadJette
Auteurs 2
InitialenSA
NaamSalman
InstituutUZ Brussel
StadJette
Auteurs 3
InitialenS
NaamNi Dhubhghaill
InstituutUZ Brussel
StadJette
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