Acanthamoeba and staphylococcal keratitis with epithelial ingrowth after laser in situ keratomileusis. Issue 1 (9th January 2022)

• Record Type: Journal Article
• Authors: Wang, Xiaorui; McAlinden, Colm; Wang, Xiaodong; Shen, Di; Wei, Wei
• Is Part Of: Journal of cataract and refractive surgery online case reports. Volume 10:Issue 1(2022)
• Page Start: e00066
• Publication Date: 2022-01-09
• DOI: 10.1097/j.jcro.0000000000000066
• Languages: English
• ISSNs: 2214-1677

Abstract

Abstract : Introduction: A rare case of Acanthamoeba and staphylococcal keratitis after femtosecond laser–assisted laser in situ keratomileusis (LASIK), managed medically and surgically (with flap lift, scraping, and povidone–iodine 5% application) is reported. Patient and clinical findings: A 25-year-old woman presented 30 months after myopic LASIK with a painless loss of vision in the right eye. Visual acuity was 20/32, and a focal stromal opacity was observed. Diagnosis, intervention, and outcomes: The patient underwent flap lift, scraping, and application of povidone–iodine 5% to the flap interface. Samples were sent to the microbiology department for microscopic, culture, and sensitivity, and the patient was commenced with topical fluconazole, levofloxacin, and fusidic acid. Giemsa staining demonstrated 2 Acanthamoeba cysts. Microscopic examination revealed gram-positive cocci and pyogenic cells. Culture on a nonnutrient agar with a lawn of Escherichia coli identified the gram-positive organism Staphylococcus aureus . The clinical situation improved, and topical steroids were added. Mild epithelial ingrowth was noted at 4 months after flap lift; however, the growth remained stable and was under observation. The final visual outcome was good (visual acuity 20/25). Conclusions: This case emphasized the importance of precise microbiological diagnosis and consideration of early flap lift in post-LASIK infectious keratitis.