A Rare Devastating Complication of Lasik: Bilateral Fungal Keratitis

Purpose. To report an unusual case of severe bilateral fungal keratitis following laser in situ keratomileusis (LASIK). Method. A 48-year-old man developed bilateral diffuse corneal infiltration two weeks after LASIK. The corneal scrapings revealed fungal filaments but cultures were negative. Results. The corneal ulceration was improved on the left eye whereas spontaneous perforation occurred and finally evisceration was needed on the right eye despite topical and systemic antifungal treatment. Conclusions. Fungal keratitis, especially with bilateral involvement, is a very rare and serious complication of LASIK surgery. Clinical suspicion is crucial because most of fungal keratitis are misdiagnosed as bacterial keratitis and can lead serious visual results, even eye loss

Sutureless amniotic membrane transplantation combined with narrow-strip conjunctival autograft for pterygium.

PubMedID: 22146880To study the efficacy and safety of sutureless amniotic membrane transplantation combined with narrow-strip conjunctival autograft and to investigate the clinical outcomes. Thirty eyes of 30 patients with primary pterygia were treated in this institutional study with excision followed by sutureless amniotic membrane transplantation combined with narrow-strip conjunctival autograft using fibrin glue tissue adhesive. The main outcome measures were the operating time for ocular surface reconstruction, the size of the pterygium and of the conjunctival autograft, postoperative complications, subjective complaints, and recurrences. The mean pterygium size was 3.12 ± 0.92 mm and the mean operating time was 4.58 ± 1.10 min. Twenty-nine patients (96.7%) had no complaints after first postoperative week. Twenty-eight (93.3%) patients had no recurrences after 1 year follow-up. The sutureless amniotic membrane transplantation combined with narrow-strip conjunctival autograft is an effective procedure with low rate of recurrence. This technique can be considered as a preferred grafting procedure for primary pterygium but further randomized controlled studies including larger populations are needed

Successful Medical Management of Recalcitrant Fusarium solani Keratitis: Molecular Identification and Susceptibility Patterns

PubMedID: 22528742Fungal keratitis is a rare but sight-threatening infection of the cornea that may be caused by several fungal pathogens. A delay in diagnosis and inadequate treatment may even lead to loss of the affected eye. Fungal keratitis is often misdiagnosed as bacterial keratitis because isolation and identification of the fungal pathogen is difficult and requires experience, and fungal growth in culture requires time. In this report, a 14-year-old boy with recalcitrant Fusarium solani keratitis, unresponsive to initial therapy, is presented. CLSI M38-A2 in vitro antifungal susceptibility tests demonstrated that only amphotericin B (0. 5 µg/ml) had potent activity against F. solani; however, fluconazole (>64 µg/ml), itraconazole (>16 µg/ml), voriconazole (8 µg/ml), and posaconazole (>16 µg/ml) had high minimum inhibitory concentrations. In addition, caspofungin (>16 µg/ml) and anidulafungin (>16 µg/ml) exhibited high minimum effective concentrations. Repeated intrastromal voriconazole injections, topical voriconazole, and caspofungin combined with systemic antifungal agents improved of the corneal lesion with a significant increase in visual acuity. Intrastromal voriconazole injection may be used as an adjunctive treatment method for recalcitrant fungal keratitis with no prominent complications. The intrastromal route could be an effective route of administration of antifungal agents, especially for F. solani keratitis, as in this case. A combination of various antifungal agents administered by different routes prevented loss of the eye. © 2012 Springer Science+Business Media B.V