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Post-Laser In Situ Keratomileusis Interface Fungal Keratitis

Mittal, Vikas MS*; Jain, Rajat MS; Mittal, Ruchi MS; Sangwan, Virender S. MS§

doi: 10.1097/ICO.0000000000000227
Clinical Science

Purpose: To report outcomes of post-laser in situ keratomileusis (LASIK) interface filamentous fungal keratitis.

Methods: This retrospective interventional case series included 6 eyes of 5 patients with microbiologically proven post-LASIK interface fungal keratitis from August 2008 to August 2013. Patients presenting with concurrent bacterial/viral keratitis, systemic illness, prior ocular pathology, or those without a minimum follow-up of 3 months were excluded. Every case underwent microbiological scrapings from residual bed and undersurface of the flap after flap lift at presentation followed by voriconazole interface wash. Flap amputation was performed when required. The outcome measure was complete resolution of infection.

Results: The mean age was 24 ± 3.1 years. The male:female ratio was 4:1. The mean interval between LASIK and symptom onset was 4.16 ± 2 days; and the mean interval between symptom onset and patient referral was 3.16 ± 1.16 days. Interface scrapings showed filamentous fungal filaments in KOH wet mount. The culture grew Aspergillus in case 1 and case 5. Infiltrated LASIK flap needed to be amputated in 4 eyes of 3 patients. Voriconazole wash (100 μg/mL) of the stromal bed was performed in all cases. A positive response to therapy with resolution of infection was seen in all cases at a mean of 6.5 ± 4.6 days. No intraoperative or postoperative complications after interface scraping or voriconazole wash were observed. The final best-corrected visual acuity ranged from 20/20 to 20/80 at a mean follow-up of 9.1 ± 6.5 months.

Conclusions: Post-LASIK interface fungal filamentous keratitis can present early and gives good outcomes with early microbiological diagnosis and appropriate management. Voriconazole is an efficient and probably safe adjunct in the armamentarium of corneal surgeons to treat such cases.

*Cornea and Anterior Segment Services, Sanjivni Eye Care, Ambala, India;

DrishtiCONE eye care, Delhi, India;

Vitreoretina Services, Sanjivni Eye Care, Ambala, India; and

§Clinical Trial Center, Dr Paul Dubord Chair in Cornea, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India.

Reprints: Rajat Jain, MBBS, MS, drishtiCONE eye care, AL-10, Shalimar Bagh, Delhi-110088, India (e-mail:

Design of the study: R. Jain and V. Mittal; conduct of the study: V. Mittal; collection, management of data: R. Jain and V. Mittal; analysis and interpretation of the data: R. Jain, V. Mittal, R. Mittal, and V. S. Sangwan; and preparation, review, or approval of the manuscript: R. Jain, V. Mittal, R. Mittal, and V. S. Sangwan.

The authors have no funding or conflicts of interest to disclose.

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Received May 16, 2014

Received in revised form June 23, 2014

Accepted June 28, 2014

© 2014 by Lippincott Williams & Wilkins.