AlBathi L, AlShabeeb R. Bipolaris keratitis following photorefractive keratectomy: Case report.
Int J Surg Case Rep 2020;
78:372-374. [PMID:
33412407 PMCID:
PMC7797370 DOI:
10.1016/j.ijscr.2020.12.051]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 11/21/2022] Open
Abstract
Photorefractive keratectomy is a common refractive surgery which has excellent outcome in correcting refractive errors.
This procedure carries the risk of infectious keratitis due to removal of epithelial layer during the procedure.
Few cases has been reported with fungal keratitis following the procedure.
In the current case the culture was positive for bipolaris species and the patient showed excellent response to medical treatment.
Early diagnosis, appropriate laboratory testing, close observation and aggressive antifungal therapy can result in good outcomes.
Introduction
Fungal keratitis is an uncommon condition that can occur after ocular surgery or trauma to the eye. Some cases have been reported after corneal refractive surgery. Most cases of keratitis following refractive surgery are due to gram-positive bacteria. However, there are a few reports in the literature of fungal and protozoal infections.
Case Presentation
A 29-year-old healthy male developed fungal keratitis Five days following photorefractive keratectomy.
Clinical findings and Investigations
The patient was admitted to the hospital, corneal scraping was performed and sent for staining and routine cultures. A corneal swab was also performed and sent for polymerase chain reaction (PCR). On day 10 post-admission, the fungal culture was positive for Bipolaris.
Intervention and Outcome
Intensive topical antifungal drops were started initially then tapered when clinical improvement was evident. The patient had good final outcome with preservation of good vision and free of symptoms six months following the infection.
Relevance and Impact
Fungal keratitis following corneal refractive surgery is rare. However, it is an infection that can potentially lead to poor outcomes if appropriate management is delayed. Therefore, a high index of suspicion is required especially when multiple risk factors is present.
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