Cystic Epithelial Ingrowth in a Case of Deep Anterior Lamellar Keratoplasty

Report of a Case. A 33-year-old man had mild photophobia and redness in his right eye with blurred vision 1 month after an uneventful bilateral LASIK procedure using the same blade for both eyes. Slitlamp examination revealed mild ciliary injection and a white corneal infiltrate in the interface 1.5 mm from the flap edge, with no overlying epithelial defect. With suspicion of bacterial keratitis, topical treatment with ciprofloxacin hydrochloride (Oftacilox) and tobramycin (Tobrex) was initiated. After the first week, the inflammation was reduced but the infiltrate increased in size; thus, lifting and scrapping were performed and samples were obtained from the stromal bed of the ulcer. The microbiological study revealed multiple acid-fast bacilli; therefore, treatment was initiated with amikacin, 0.1%, clarithromycin, 1%, vancomycin hydrochloride, 1%, moxifloxacin, 0.3% (Vigamox), and oral clarithromycin. The intensive treatment failed to control the infection and the infiltrate coalesced, with new satellite lesions appearing (Figure 1). The final result of the culture showed M chelonae resistant to amikacin and clarithromycin; thus, topical linezolid (2 mg/mL) was initiated (6 times daily). Both the infiltrate and the inflammation improved dramatically after the first week of treatment. Control of the infection was achieved after 2 months (Figure 2). Although the final examination revealed a subtle leukoma, the final visual acuity was 20/30 OD and 20/40 OS.