Aspergillus flavus keratitis after laser in situ keratomileusis

PURPOSE: To report a case of fungal keratitis caused by Aspergilluts flavus after laser in situ keratomileusis surgery. METHODS: Case report. A 24-year-old woman developed pain, redness, decrease d vision, and an infiltrate posterior to the corneal flap in her right eye 3 days after laser in situ keratomileusis. On referral, approximately 3 wee ks after laser in situ keratomileusis, examination of the right eye reveale d light perception vision, a large full-thickness corneal infiltrate, and h ypopyon. Corneal scrapings were taken for direct microscopic examination an d culture, RESULTS: Corneal scraping revealed the presence of fungal filaments in smea rs and in culture. The fungus was identified as A. flavus. Intensive topica l natamycin and systemic ketoconazole therapy was initiated. Despite intens ive medical treatment, the infiltrate progressed and the patient was subjec ted to a therapeutic penetrating keratoplasty. There was no recurrence of i nfection after surgery, At last follow up 4 months after surgery, the eye w as quiet with graft edema. CONCLUSION: Fungal keratitis is a rare complication of laser in situ kerato mileusis surgery. In a case that does not respond to medical treatment, ear ly surgical intervention must be considered, (C) 2000 by Elsevier Science I nc, All rights reserved.