We appreciate the comments made by Dr. Tripathi and are glad to have the chance to reply and clarify his points.
1. We were not wrong in claiming that the case reported by us was the first case of fungal keratitis following LASIK. Although both case reports referred to by Dr. Tripathi appeared in the year 2000, earlier than ours, there was no published report of fungal keratitis following LASIK when our article was accepted for publication, ie, December 8, 1999.
2. We fully agree with Dr. Tripathi that it is important to perform a thorough microbiology workup in all cases of post-LASIK infectious keratitis. A review of published cases clearly indicates that a variety of micro-organisms including Mycobacteria,1Nocardia,2 and even fungi are involved in post-LASIK infectious keratitis. Therefore, many of these cases may not respond to empirical therapy with broad-spectrum antibiotics, as highlighted in the case reported by us. A detailed microbiology workup will help to identify the etiological agent and institute appropriate treatment early.
We would like to add that to increase the probability of isolating the etiologic agent, the specimen must be collected directly from the site of the lesion. This may involve raising the partial-thickness flap and performing corneal scrapings from the stromal bed, because the infiltrate is located at the interface in most of these cases.
3. Although this complication is rare, it is very important to avoid it, keeping in mind the sight-threatening sequelae associated with it. Careful selection of the case, detailed preoperative workup, and maintenance of strict asepsis during surgery can help prevent this.
Prashang Garg MS
Aahish K. Bansal MS
1. Raviglio V, Rodriguez ML, Picotti GS, et al. Mycobacterium chelonae keratitis following laser in situ keratomileusis. J Refract Surg 1998; 14:357-360
2. Pérez-Santonja JJ, Sakla HF, Abad JL, et al. Nocardial keratitis after laser in situ keratomileusis. J Refract Surg 1997; 13:314-317