— INFECTIOUS KERATITIS —

POSSIBLE ETIOLOGY: Mycobacterial

SURGICAL MANAGEMENT

A minor surgical procedure was performed on the left eye to relift the flap and obtain a scraping of the corneal infiltrate for reculture, as described below.

1. Clean the area beneath the flap.
2. Irrigate the area with ciprofloxacin 0.3%.
3. Remove epithelial ingrowth.
4. Reseat and anchor the flap to the corneal bed with 4 interrupted 10-0 nylon sutures.

OBSERVATIONS

• Infero-nasal quadrant of the flap is necrotic and missing.
• Marked thinning beneath the flap with presence of small descemetocele.

BIOPSY: A biopsy of the flap in an area of necrosis was also performed in the left eye for culture and pathology.

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SURGEON'S VIEW OS
*Figure 1. Corneal flap		Figure 2. Biopsy of necrotic flap
Figure 3. Suturing procedure		Figure 4. Flap secured with sutures
*Figure 1. Bold arrow: infiltrate at base of flap; Light arrow: area of necrosis/flap loss
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CULTURE PROCEDURE

• Plate the collected infiltrate on blood, chocolate, and Sabouraud agar plates
• Microscopic examination

MEDICAL MANAGEMENT

• Bandage contact lens
• Ciprofloxacin (Ciloxan) q 0.5 h
• Fortified amikacin q 1 h
• Doxycycline 100 mg, po, bid