Abstract
PURPOSE: We report a case of interface Candida keratitis following laser assisted lenticule extraction (LALEX) surgery. Fungal keratitis post LALEX is exceptionally rare and only 2 case reports of Aspergillosis have been reported. OBSERVATIONS: A 26-year-old male healthcare worker presented five weeks post LALEX surgery in Korea with hazy vision in the left eye with corrected distance visual acuity (CDVA) of 20/200. Two anterior infiltrates were present within the interface with significant corneal edema. A specimen was obtained from hydrodissecting the interface. The subepithelial LALEX pocket was irrigated initially with vancomycin and then voriconazole once the yeast was identified. Microbiology confirmed Candida Parapsilosis. Two LALEX pocket injections of amphotericin B were then given two days apart as well as intensive topical therapy of amphotericin B, voriconazole and cyclosporine combined with oral voriconazole. The keratitis resolved, leaving mud cracking scarring at the interface. Use of losartan 0.8mg/mL eyedrops 6 times a day appeared to reduce scarring over 6 months with a final CDVA of 20/32. CONCLUSIONS AND IMPORTANCE: C. parapsilosis is a commensal on human skin and can be acquired exogenously from the hands of healthcare workers. The organism is highly susceptible to amphotericin B, making a washout with amphotericin B an ideal first choice for management. C. parapsilosis secretes hydrolytic enzymes, which may have contributed to the stromal scarring at the interface. Topical losartan is a potential safe new modality for reducing corneal scarring at the LALEX interface, however more evidence is needed to prove its efficacy.