Infectious Keratitis Following Laser In Situ Keratomileusis: A Battle For Vision Recovery

We report a case of severe infectious keratitis following laser in situ keratomileusis (LASIK), successfully managed through a combination of antibiotic therapy, flap amputation, corneal cross-linking, and ultimately, penetrating keratoplasty. The residual refractive error was managed with the implantation of a toric implantable collamer lens (ICL).

Ophthalmology Department of Habib Thameur University Hospital, Tunis, Tunisia.

A 28-year-old healthy female underwent uneventful bilateral femto-LASIK. Initial post-operative recovery was unremarkable. However, by day five, she developed visual blurring, pain, and conjunctival injection in her right eye. Infectious keratitis was suspected, and empirical topical and systemic broad-spectrum antibiotic and antifungal therapy were initiated. As symptoms worsened, she presented to our department on day 18 for further evaluation. Upon presentation, her visual acuity was limited to counting fingers. Slit-lamp examination revealed a central corneal abscess with multiple adjacent corneal infiltrates. On day 20, the corneal flap was removed, and corneal scraping was performed. However, bacteriological tests along with multiplex polymerase chain reaction were negative. By day 30, corneal cross-linking was performed to stop the progression of stromal necrosis. Despite initial stabilization, lesion progression necessitated emergency penetrating keratoplasty. The patient was kept under antifungal and antibiotic prophylactic therapy. After a 15-month follow-up period and suture removal, the graft remained clear, with no signs of infection recurrence. To correct the residual refractive error of -9.00 /-3.00 x150°, a toric ICL was implanted, achieving a final visual acuity of 20/30.

This case highlights the diagnostic and therapeutic challenges of severe post-LASIK infectious keratitis. Early suspicion, pathogen-specific identification, and aggressive management, including prompt surgical interventions when needed, are crucial for preserving vision.