Very late onset LASIK flap Acremonium fungal keratitis confirmed by metagenomic deep sequencing.
Am J Ophthalmol Case Rep
; 25: 101294, 2022 Mar.
Article
em En
| MEDLINE
| ID: mdl-35128155
ABSTRACT
PURPOSE:
To describe a unique case of LASIK flap fungal keratitis confirmed by next generation sequencing. OBSERVATIONS A 56-year-old female presented with refractory keratitis involving her LASIK flap 21 years after surgery. Confocal was positive for filamentous structures. The patient underwent immediate flap amputation followed by topical antifungal treatment. Corneal culture was positive for Acremonium sp. Metagenomic deep sequencing confirmed Acremonium as the primary source of infection and also identified Fusarium as a likely contributor of a mixed fungal infection. Sequencing also identified hay as the likely source of the infection. Treatment resulted in eradication of the infection. The patient's final best corrected visual acuity was 20/30 with rigid contact lens overrefraction.CONCLUSIONS:
Metagenomic deep sequencing is a novel diagnostic tool that is increasingly being utilized for diagnosis of refractory keratitis. This case demonstrates the diagnostic potential of deep sequencing for identifying post-LASIK keratitis and reinforces the utility of LASIK flap amputation in the setting of tectonic flap instability due to keratolysis. IMPORTANCE This case highlights several important clinical points for treating LASIK flap keratitis and highlights the emerging role metagenomic sequencing has in the diagnosis of infectious keratitis. This is first known case using next generation sequencing to diagnose a post-LASIK infectious keratitis.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Prognostic_studies
Idioma:
En
Revista:
Am J Ophthalmol Case Rep
Ano de publicação:
2022
Tipo de documento:
Article