Abstract

P 157

Bilateral iatrogenic fungal keratitis following Laser-in-situ-Keratomileusis

Leonie Troeber, Ursula Löw, Frank Schirra, Berthold Seitz
Klinik für Augenheilkunde, Universitätskliniken des Saarlandes, Homburg/Saar

Objective
Today, Laser-in-situ-Keratomileusis (LASIK) is a well-established procedure to treat refractive errors and is usually performed on both eyes at the same day.
Methods
Case-report
Results
A 16-year-old male who wanted to become a policeman underwent LASIK on both eyes (preoperative refraction OD / OS -2,5 diopters). Three days after the operation he presented with OS > OD massive conjunctival redness and corneal  infiltrates in the anterior stroma (interface). Visual acuity was 0.6 on the right eye and 0.3p on the left eye. Topical treatment included Amphotericine B eyedrops (ED), Cefuroxime fortified 5 % ED, Tobramycine fortified 4.2% ED, Polymyxine B, Bacitracine and Neomycine ointment at night. Intravenous therapy included VFEND, Rocephin and Doxycycline. We lifted the flap sequentially in both eyes and performed an interface-lavage with Vancomycine, Amphotericine B and Iodine 5%. After weeks the infiltrates converted to stable scars. Steroids were added after a few days and therapy was tapered very slowly. Visual acuity improved to 1.25 on the right and 0.9 on the left eye despite multifocal paracentral scars persisting in the interface. With PCR (polymerase chain reaction) fusarium oxysporum / galaktomyces geotrichunm was found.
Conclusions
Although LASIK is considered as a safe procedure today, it bears the risk of loosing vision and potentially the eye. However, timely adequate treatment (incl. flap-lifting) may result in good visual prognosis after iatrogenic fungal keratitis.

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