Early post-LASIK flap amputation in the treatment of aggressive, branching keratitis: a case report

Au, John; Plesec, Thomas; Rocha, Karolinne Maia; Dupps, William J.; Krueger, Ronald R.

doi:10.5935/0004-2749.20160016

Cited by 3 publications

(2 citation statements)

References 6 publications

(13 reference statements)

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“…1 These complications are often challenging to treat, and flap amputation is sometimes necessary to adequately control corneal disease. Infectious keratitis 2–4 and epithelial ingrowth 5–9 have previously been reported as the most common indications for flap amputation, and our findings were in agreement. In our series, although flap amputation assisted in controlling the underlying disease process in all cases with overall satisfactory final vision, some eyes required significant further intervention or sustained loss of best visual acuity.…”

Section: Discussionsupporting

confidence: 92%

“…Overall, the final median best visual acuity was 20/25, similar to that reported by other investigators. 2–4,7–9 Chhadva et al 3 found better UCVA after flap amputation for epithelial ingrowth (20/30, 3 eyes) than for infectious keratitis (20/50, 5 eyes). Our findings were similar with better final median best visual acuity in noninfectious cases compared with infectious cases after correcting for significant irregular astigmatism from corneal scarring by using rigid contact lenses.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of Flap Amputation After Laser In Situ Keratomileusis

Castillejo Becerra,

Maguire,

Salomao

et al. 2023

Cornea

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Purpose: The aim of this study was to describe the indications and outcomes of flap amputation after laser in situ keratomileusis (LASIK) at a referral-based institution. Methods: In this retrospective consecutive case series, medical records of patients who underwent LASIK flap amputation at Mayo Clinic, Rochester, MN, between January 1, 1998, and January 31, 2023, were reviewed. Results: Fifteen eyes (15 patients) underwent flap amputation during the study period. The median age was 45 years (range, 25–71 years), and 8 patients (53%) were men. The median uncorrected visual acuity before flap amputation was 20/200 (range 20/40-hand motions). Indications for flap amputation included epithelial ingrowth (n = 6, 40%), infectious keratitis (n = 6, 40%), diffuse lamellar keratitis (n = 1, 7%), vegetative foreign body (n = 1, 7%), and astigmatism from fixed flap striae (n = 1, 7%). The median duration of follow-up was 8 months (range 1–234 months). Subsequent corneal interventions included chelation of calcific band keratopathy (n = 1, 7%), lamellar keratoplasty (n = 1, 7%), penetrating keratoplasty (n = 2, 18%), keratoprosthesis (n = 1, 7%), and rigid contact lens wear (n = 4, 27%). The final median best visual acuity was 20/25 (range 20/20–20/200). Compared with noninfectious indications for flap amputation, eyes with infectious indications had worse baseline median uncorrected visual acuity (hand motions vs. 20/63, P < 0.001), were more likely to undergo major corneal surgical intervention (50% vs. 11%), and had worse final median best visual acuity (20/50 vs. 20/20, P = 0.018). Conclusions: LASIK flap amputation is sometimes necessary to control threatening corneal diseases. Excellent visual outcomes were achieved in most cases, albeit with additional intervention or rigid contact lens wear.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Outcomes of Flap Amputation After Laser In Situ Keratomileusis

Castillejo Becerra,

Maguire,

Salomao

et al. 2023

Cornea

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Accelerated corneal crosslinking to treat Acanthamoeba and Fusarium coinfection of the cornea

Passilongo

Pedrotti

Talli

et al. 2018

Journal of Cataract and Refractive Surgery Online Case Reports

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Infectious Keratitis After Keratorefractive Surgery: Update and Review of the Literature

Liu

Guo

Wei

et al. 2023

Eye &Amp; Contact Lens: Science &Amp; Clinical Practice

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Objectives:To summarize the clinical manifestations, microbiological profile, treatment, and prognosis of corneal infections after different keratorefractive surgery.Methods:To obtain relevant studies, English-language databases, including PubMed, Ovid Embase, Web of Science, and CLNAHL, were searched from January 1979 to March 2022. The fundamentals of the literature, clinical characteristics, pathogens, and treatments were retrieved for each included article.Results:Eighty-four studies involving 306 infectious eyes were included in this review. Risk factors of potential infection included a history of blepharitis, contact lens usage, and contaminated surgical instruments. The mean onset time was 22.9±38.7 days (range: 1 day to 3 years). The most common organism isolated from infectious keratitis after keratorefractive surgery were Staphylococcus aureus, followed by Mycobacterium and coagulase-negative Staphylococcus. Most of the infections after refractive procedures were sensitive to medical treatment alone, and the ultimate best-corrected visual acuity after medical treatment was as follows: 20/20 or better in 82 cases (37.0%), 20/40 or better in 170 cases (76.5%), and worse than 20/40 in 52 cases (23.5%). Surgical interventions including flap lift, flap amputation, ring removal, and keratoplasty were performed in 120 eyes (44.5%).Conclusions:Most infections after keratorefractive surgery occur within a week, whereas more than half of the cases after laser-assisted in situ keratomileusis happen after about a month. Gram-positive cocci and mycobacterium are the most common isolates. Infections after LASIK, intracorneal ring (ICR) implantation, and small incision lenticule extraction, which primarily occur between the cornea layers, require irrigation of the tunnels or pocket with antibiotics.

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Early post-LASIK flap amputation in the treatment of aggressive, branching keratitis: a case report

Cited by 3 publications

References 6 publications

Outcomes of Flap Amputation After Laser In Situ Keratomileusis

Outcomes of Flap Amputation After Laser In Situ Keratomileusis

Accelerated corneal crosslinking to treat Acanthamoeba and Fusarium coinfection of the cornea

Infectious Keratitis After Keratorefractive Surgery: Update and Review of the Literature

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