A case of intractable infectious keratitis and subsequent flap necrosis after laser in situ keratomileusis

Kazutaka Kamiya, Masayuki Kasahara, Kimiya ShimizuDepartment of Ophthalmology, University of Kitasato School of Medicine, JapanAbstract: We report on a patient in whom intractable infectious keratitis and subsequent lamellar flap necrosis necessitating flap amputation after laser in situ keratomileu...

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Autores principales:	Kazutaka Kamiya, Masayuki Kasahara, Kimiya Shimizu
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2009
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/5730f9f8b7e4470ba96e40f34c0fcceb
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spelling	oai:doaj.org-article:5730f9f8b7e4470ba96e40f34c0fcceb2021-12-02T00:11:58ZA case of intractable infectious keratitis and subsequent flap necrosis after laser in situ keratomileusis1177-54671177-5483https://doaj.org/article/5730f9f8b7e4470ba96e40f34c0fcceb2009-09-01T00:00:00Zhttp://www.dovepress.com/a-case-of-intractable-infectious-keratitis-and-subsequent-flap-necrosi-a3554https://doaj.org/toc/1177-5467https://doaj.org/toc/1177-5483Kazutaka Kamiya, Masayuki Kasahara, Kimiya ShimizuDepartment of Ophthalmology, University of Kitasato School of Medicine, JapanAbstract: We report on a patient in whom intractable infectious keratitis and subsequent lamellar flap necrosis necessitating flap amputation after laser in situ keratomileusis (LASIK). A 34-year-old woman undergoing LASIK complained of blurred vision and pain in the left eye. The best spectacle-corrected visual acuity was 0.01, and slit-lamp examination showed a marked presence of stromal infiltrates involving the flap and the underlying stroma in that eye. The patient was treated topically with hourly instillation of micronomicin, levofloxacin, and cefmenoxime, together with systemic administration of imipenem, but the left eye developed corneal flap necrosis. We performed surgical debridement of the diseased stroma and excised the lamellar flap. Since nontuberculous mycobacterium was detected on the surgical instruments, we then added oral clarithromycin, and substituted systemic administration of amikacin with that of imipenem. At one month after the flap removal, the visual acuity gradually improved to 0.7, but the stromal opacity of the central cornea and hyperopic shift of +3.0 diopters remained. LASIK can cause intractable keratitis, resulting in significant visual disturbance that presumably results from insufficient antisepsis of the medical instruments used for this surgery, supporting the importance of strict sterilization of these instruments.Keywords: infectious keratitis, flap necrosis, nontuberculous mycobacterium, sterilization, LASIK Kazutaka KamiyaMasayuki KasaharaKimiya ShimizuDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2009, Iss default, Pp 523-525 (2009)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Kazutaka Kamiya Masayuki Kasahara Kimiya Shimizu A case of intractable infectious keratitis and subsequent flap necrosis after laser in situ keratomileusis
description	Kazutaka Kamiya, Masayuki Kasahara, Kimiya ShimizuDepartment of Ophthalmology, University of Kitasato School of Medicine, JapanAbstract: We report on a patient in whom intractable infectious keratitis and subsequent lamellar flap necrosis necessitating flap amputation after laser in situ keratomileusis (LASIK). A 34-year-old woman undergoing LASIK complained of blurred vision and pain in the left eye. The best spectacle-corrected visual acuity was 0.01, and slit-lamp examination showed a marked presence of stromal infiltrates involving the flap and the underlying stroma in that eye. The patient was treated topically with hourly instillation of micronomicin, levofloxacin, and cefmenoxime, together with systemic administration of imipenem, but the left eye developed corneal flap necrosis. We performed surgical debridement of the diseased stroma and excised the lamellar flap. Since nontuberculous mycobacterium was detected on the surgical instruments, we then added oral clarithromycin, and substituted systemic administration of amikacin with that of imipenem. At one month after the flap removal, the visual acuity gradually improved to 0.7, but the stromal opacity of the central cornea and hyperopic shift of +3.0 diopters remained. LASIK can cause intractable keratitis, resulting in significant visual disturbance that presumably results from insufficient antisepsis of the medical instruments used for this surgery, supporting the importance of strict sterilization of these instruments.Keywords: infectious keratitis, flap necrosis, nontuberculous mycobacterium, sterilization, LASIK
format	article
author	Kazutaka Kamiya Masayuki Kasahara Kimiya Shimizu
author_facet	Kazutaka Kamiya Masayuki Kasahara Kimiya Shimizu
author_sort	Kazutaka Kamiya
title	A case of intractable infectious keratitis and subsequent flap necrosis after laser in situ keratomileusis
title_short	A case of intractable infectious keratitis and subsequent flap necrosis after laser in situ keratomileusis
title_full	A case of intractable infectious keratitis and subsequent flap necrosis after laser in situ keratomileusis
title_fullStr	A case of intractable infectious keratitis and subsequent flap necrosis after laser in situ keratomileusis
title_full_unstemmed	A case of intractable infectious keratitis and subsequent flap necrosis after laser in situ keratomileusis
title_sort	case of intractable infectious keratitis and subsequent flap necrosis after laser in situ keratomileusis
publisher	Dove Medical Press
publishDate	2009
url	https://doaj.org/article/5730f9f8b7e4470ba96e40f34c0fcceb
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A case of intractable infectious keratitis and subsequent flap necrosis after laser in situ keratomileusis

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