Fungal Keratitis After Radial Keratotomy

Abstract

Inquiries to Eduardo Alfonso, M.D., Bascom Palmer Eye Institute, P.O. Box 016880, Miami, FL 33101. A 35-year-old woman had a history of Crohn's disease that was treated with sulfasalazine. The patient had six-incisional radial kera­ totomy of both eyes; the right eye in October 1990, and the left eye in January 1991. Postoperatively the right eye had done well. However, two weeks postoperatively, the left eye became red and irritated while on a regimen of antibiot­ ic and corticosteroid drops. The surgeon noted an infiltrate in the central aspect of the 5 o'clock incision. The patient was treated with topical fortified cefazolin, fortified tobramycin, and dexamethasone without improvement. Cul­ tures yielded no growth. On March 6, 1991, the patient was referred to a corneal specialist be­ cause of continued irritation and pain. A diag­ nosis of crystalline keratopathy was made. The wound at the 5 o'clock incision was irrigated with vancomycin (50 mg/ml) . Vancomycin (50 mg) and gentamicin (40 mg) were injected subconjunctivally, and the patient was given topi­ cal fortified cefazolin, fortified tobramycin, Neosporin, and fluorometholone 0.25%. Re­ peat cultures yielded no growth. On March 18,