Combined treatment with flap amputation, phototherapeutic keratectomy, and collagen crosslinking in severe intractable post-LASIK atypical mycobacterial infection with corneal melt

J Cataract Refract Surg. 2012 Apr;38(4):713-5. doi: 10.1016/j.jcrs.2012.01.009. Epub 2012 Feb 23.

Abstract

A 23-year-old woman was referred for management of intractable post-laser in situ keratomileusis (LASIK) keratitis due to atypical mycobacteria in the left eye. Corrected distance visual acuity was 20/20 in the right eye and counting fingers at 3 meters in the left eye. Slitlamp examination revealed multiple infiltrates in the flap interface and severe corneal stromal melting with thinning. Despite maximum antibiotic therapy for 7 days, the keratitis continued to worsen. A penetrating keratoplasty (PKP) was scheduled. While waiting for a corneal graft, corneal collagen crosslinking (CXL) with riboflavin and ultraviolet-A was proposed as an alternative treatment. Flap amputation and limited phototherapeutic keratotomy (PTK) (10 μm) were also performed. One week postoperatively, all infiltrates and stromal edema had resolved. At 3 months, the uncorrected distance visual acuity improved to 20/35. Corneal crosslinking after flap amputation and limited PTK was an effective treatment for severe intractable post-LASIK keratitis with corneal melting and obviated PKP.

Publication types

  • Case Reports

MeSH terms

  • Amputation*
  • Collagen / metabolism*
  • Combined Modality Therapy
  • Corneal Stroma / metabolism
  • Corneal Stroma / surgery
  • Corneal Ulcer / microbiology
  • Corneal Ulcer / therapy
  • Cross-Linking Reagents / metabolism*
  • Eye Infections, Bacterial / drug therapy
  • Eye Infections, Bacterial / microbiology
  • Eye Infections, Bacterial / surgery
  • Eye Infections, Bacterial / therapy*
  • Female
  • Humans
  • Keratomileusis, Laser In Situ*
  • Mycobacterium Infections, Nontuberculous / drug therapy
  • Mycobacterium Infections, Nontuberculous / microbiology
  • Mycobacterium Infections, Nontuberculous / surgery
  • Mycobacterium Infections, Nontuberculous / therapy*
  • Photorefractive Keratectomy*
  • Photosensitizing Agents / therapeutic use
  • Postoperative Complications
  • Riboflavin / therapeutic use
  • Surgical Flaps / pathology
  • Ultraviolet Rays
  • Visual Acuity / physiology
  • Young Adult

Substances

  • Cross-Linking Reagents
  • Photosensitizing Agents
  • Collagen
  • Riboflavin