Delayed-onset multifocal polymicrobial keratitis after laser in situ keratomileusis

Ritterband, David C.; Kelly, James K.; McNamara, Tara; Kresloff, Michael; Koplin, Richard S.; Seedor, John A.

doi:10.1016/s0886-3350(01)01015-x

Cited by 21 publications

(7 citation statements)

References 5 publications

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“…Only two of these patients responded to medical therapy alone; penetrating keratoplasty was ultimately required for the other four patients. Some workers (203,327,360,361) feel that although mycotic keratitis following this surgical procedure is rare, it may pose an important therapeutic challenge due to poor intracorneal penetration of antifungals, especially through an intact epithelium. Sampling at the site of infection provides the best chance of obtaining a positive culture.…”

Section: Fungal Ocular Infections After Ophthalmic Surgical Proceduresmentioning

confidence: 99%

Current Perspectives on Ophthalmic Mycoses

2003

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Fungi may infect the cornea, orbit and other ocular structures. Species of Fusarium, Aspergillus, Candida, dematiaceous fungi, and Scedosporium predominate. Diagnosis is aided by recognition of typical clinical features and by direct microscopic detection of fungi in scrapes, biopsy specimens, and other samples. Culture confirms the diagnosis. Histopathological, immunohistochemical, or DNA-based tests may also be needed. Pathogenesis involves agent (invasiveness, toxigenicity) and host factors. Specific antifungal therapy is instituted as soon as the diagnosis is made. Amphotericin B by various routes is the mainstay of treatment for life-threatening and severe ophthalmic mycoses. Topical natamycin is usually the first choice for filamentous fungal keratitis, and topical amphotericin B is the first choice for yeast keratitis. Increasingly, the triazoles itraconazole and fluconazole are being evaluated as therapeutic options in ophthalmic mycoses. Medical therapy alone does not usually suffice for invasive fungal orbital infections, scleritis, and keratitis due to Fusarium spp., Lasiodiplodia theobromae, and Pythium insidiosum. Surgical debridement is essential in orbital infections, while various surgical procedures may be required for other infections not responding to medical therapy. Corticosteroids are contraindicated in most ophthalmic mycoses; therefore, other methods are being sought to control inflammatory tissue damage. Fungal infections following ophthalmic surgical procedures, in patients with AIDS, and due to use of various ocular biomaterials are unique subsets of ophthalmic mycoses. Future research needs to focus on the development of rapid, species-specific diagnostic aids, broad-spectrum fungicidal compounds that are active by various routes, and therapeutic modalities which curtail the harmful effects of fungus- and host tissue-derived factors

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Section: Fungal Ocular Infections After Ophthalmic Surgical Proceduresmentioning

confidence: 99%

Current Perspectives on Ophthalmic Mycoses

2003

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“…The reports of etiologies of infectious keratitis include atypical mycobacterium, S aureus, Streptococcus viridians, fungus, Nocardia, S pneumonia, Acanthamoeba, and Pseudomonas aeruginosa. [1][2][3][4]6 Fungal keratitis is a rare complication. Three cases of Aspergillus fumigatus infection after LASIK have been reported, 6-8 one of which resulted in perforation.…”

Section: Discussionmentioning

confidence: 99%

Aspergillus fumigatus keratitis following laser in situ keratomileusis

Sun

Jain

2007

Journal of Cataract and Refractive Surgery

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A 31-year-old woman developed pain, decreased vision, and a corneal flap infiltrate 4 days following laser in situ keratomileusis (LASIK). Treatment with topical antibiotic agents did not improve the symptoms. Approximately 2 weeks after surgery, the patient was referred to Stanford University, with 20/400 visual acuity in the left eye and a stromal infiltrate posterior to the flap. Cultures demonstrated Aspergillus fumigatus sensitive to voriconazole. The corneal ulcer progressed despite aggressive antifungal treatment, requiring amputation of the corneal flap and daily debridement. The infiltrate resolved in response to topical voriconazole, natamycin, and oral voriconazole. Aspergillus fumigatus keratitis is a rare but serious complication of LASIK surgery. The infection was successfully treated with flap amputation and daily debridement in addition to antifungal therapy.

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“…Fungal keratitis may be caused by various filamentous fungi, such as Fusarium [30] and Aspergillus [31][32][33][34], or by yeasts, such as Candida.…”

Section: Fungal Keratitismentioning

confidence: 99%

Microbial Keratitis after Corneal Laser Refractive Surgery

Sharma¹,

Sharma

Wilkins

2011

Future Microbiol.

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Corneal laser refractive surgery is increasingly being performed on patients with the aim of improving unaided vision. Most candidates for surgery have excellent spectacle- or contact lens-corrected vision. Although microbial keratitis following refractive surgery is a rare complication, and usually has a good visual outcome, it can be sight-threatening. The spectrum of pathogens differs to other causes of microbial keratitis, such as contact lens-associated keratitis, and a different management approach is required. Postoperatively, patients are prescribed topical steroids and broad-spectrum topical antibiotics, typically fluoroquinolones. These do not cover unusual organisms, such as fungi, Nocardia, Acanthamoeba and some atypical mycobacteria. In post-laser-assisted in situ keratomileusis microbial keratitis, the lamellar flap should be lifted to acquire samples for specific microbiological examination, including these atypical organisms. Confocal microscopy is a noninvasive test that provides morphological information, and is operator dependent, but may assist in the rapid diagnosis of fungal, Acanthamoeba or Norcardia keratitis. PCR is not in widespread use, but has high sensitivity and specificity, and may facilitate early diagnosis and specific treatment of the causative organism, which is critical in obtaining the best clinical outcome.

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Delayed-onset multifocal polymicrobial keratitis after laser in situ keratomileusis

Cited by 21 publications

References 5 publications

Current Perspectives on Ophthalmic Mycoses

Current Perspectives on Ophthalmic Mycoses

Aspergillus fumigatus keratitis following laser in situ keratomileusis

Microbial Keratitis after Corneal Laser Refractive Surgery

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