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This abstract is assigned to session AOB Free Papers 1

Presentation type	Oral presentation
Title	LASIK Flap Amputation Following Fulminant Postoperative Keratitis

Purpose	To report a rare case of presumed fungal keratitis requiring LASIK flap amputation.
Methods	A 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.
Results	Intensive 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.
Conclusion	Presumed 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.
Conflict of interest	No

Authors 1

Initials	S
Last name	Ameli
Department	UZ Brussel
City	Jette

Authors 2

Initials	SAM
Last name	Salman
Department	UZ Brussel
City	Jette

Authors 3

Initials	S
Last name	Ni Dhubhghaill
Department	UZ Brussel
City	Jette