Case Series of Perforated Keratomycosis after Laser-Assisted In Situ Keratomileusis

Table 2

Clinical and microbiological features of patients.

Cases	Medical and surgical interventions	Indication for fresh multilayered AMT	Culture	Initial clinical signs	Presenting BCVA	Prior medical history and surgical interventions	Final BCVA
1	Flap amputation, amphotericin B 50 mcg/ml (interface wash, intrastromal injection), topical (amphotericin B 0.15%, natamycin 5%), oral (itraconazole, doxycycline, acetazolamide)	2.5 mm perforation	Aspergillus fumigatus	Lid edema, chemosis, ciliary injection, cornea (hypothesia, central interface infiltrates 3x3 mm, endothelial plaque, heaped up 3 mm hypopyon, dehiscent LASIK flap), T++	20/200	Topical (moxifloxacin, natamycin, vancomycin, ceftazidime), oral (doxycycline, acetazolamide), LASIK, subconjunctival injection of vancomycin, ceftazidime	20/20
2	Flap amputation, amphotericin B 50 mcg/ml (interface wash, intrastromal and intracameral injection), topical (amphotericin B 0.15%, natamycin 5%), oral (itraconazole, doxycycline)	3.5 mm perforation	Aspergillus fumigatus	Lid edema, chemosis, ciliary injection, cornea (hypothesia, central interface infiltrates  mm, endothelial plaque, heaped up hypopyon, macerated LASIK flap), Tn	CF close to the face	Topical (moxifloxacin, natamycin, vancomycin, ceftazidime), LASIK, subconjunctival injection of vancomycin, ceftazidime	20/40
3	Amphotericin B 50 mcg/ml (interface wash, intrastromal injection), topical (amphotericin B 0.15%, natamycin 5%), oral (itraconazole, doxycycline, acetazolamide)	3.5 mm perforation	Aspergillus fumigatus	Lid edema, chemosis, ciliary injection, cornea (hypothesia, inferior interface infiltrates  mm, endothelial plaque, heaped up 1 mm hypopyon, healthy LASIK flap), T++	HM	Topical (moxifloxacin, natamycin, vancomycin, amikacin), oral (doxycycline), LASIK, subconjunctival injection of vancomycin, amikacin	20/40
4	Flap amputation, amphotericin B 50 mcg/ml (interface wash, intrastromal injection), topical (amphotericin B 0.15%, natamycin 5%), oral (itraconazole, doxycycline)	4 mm perforation	Aspergillus fumigatus	Lid edema, chemosis, ciliary injection, cornea (hypothesia, central interface infiltrates  mm, endothelial plaque, heaped up 1.5 mm hypopyon, macerated LASIK flap), T+	CF close to the face	Topical (moxifloxacin, vancomycin, ceftazidime, natamycin), oral (acetazolamide), LASIK, subconjunctival injection of vancomycin, ceftazidime	20/20
5	Flap amputation, amphotericin B 50 mcg/ml (interface wash, intrastromal and intracameral injection twice), topical (amphotericin B 0.15%, natamycin 5%), oral (itraconazole, doxycycline)	4.5 mm perforation	Aspergillus fumigatus	Lid edema, ciliary injection, cornea (hypothesia, central interface infiltrates  mm, endothelial plaque, peripheral satellites, heaped up 3 mm hypopyon, melted LASIK flap), Tn	HM	Topical (moxifloxacin, natamycin, vancomycin, ceftazidime), oral (fluconazole, vitamin C, doxycycline), LASIK, Interface wash with (steroid, moxifloxacin, BSS), subconjunctival injection of vancomycin, ceftazidime	20/80