J Korean Ophthalmol Soc.  2008 Jan;49(1):164-168. 10.3341/jkos.2007.49.1.164.

A Case Report of Fungal Keratitis Diagnosed by Femtosecond Laser Assisted Corneal Biopsy

• Yum JH
• Choi SK
• Lee JH
• Lee DH
• Kim JH

• KMID: 2211199
• DOI: http://doi.org/10.3341/jkos.2007.49.1.164

Abstract

PURPOSE: To describe femtosecond laser-assisted corneal biopsy and its use in assessing the causative organism in a case of fungal keratitis that occurred 8 months after penetrating keratoplasty.
CASE SUMMARY
A 27-year-old man who had undergone penetrating keratoplasty 8 months prior showed atypical diffuse corneal haze and erosion. Diagnostic corneal biopsy using a femtosecond laser was performed because of repeated negative test results for an infectious organism and a lack of improvement, despite steroid and empirical antibiotic therapy. A corneal flap 200 micrometer in depth and 3 mm in diameter was obtained. The biopsy showed pseudohyphae, which led to a diagnosis of Candidal keratitis. No complications occurred during the procedure.
CONCLUSIONS
Femtosecond laser-assisted corneal biopsy enabled identification of the infectious pathogen. This technique is easy, safe, and rapid, and it yields a biopsy specimen with a uniform depth and precise size. Femtosecond laser-assisted corneal biopsy can be used as an accurate diagnostic method in uncertain cases of corneal ulcers.

Keyword

Corneal biopsy; Femtosecond laser; Fungal keratitis

MeSH Terms

Adult
Biopsy
Humans
Keratitis
Keratoplasty, Penetrating

Figure

• 

  Figure 1. The photograph shows diffuse corneal haze with multiple whitish dot shape infiltrations (arrows) 8 months after keratoplasty (left). Aggravated corneal infiltration and stromal melting (dot arrows) at the margin of epithelial defect is noted 3 weeks after empirical therapy (right).

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  Figure 2. Center of application cone for Femtosecond laser is located at the margin of opacity by deviating eyeball toward inferotemporal side in order to get specimen containing both affected and normal tissue. Corneal biopsy (200 µm×3 mm) is being performed by Femtosecond laser (white circle).

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  Figure 3. Spores and pseudohyphae (black arrow) invade the corneal stroma in the histopathologic examination of the biopsy tissue. (Right, periodic acid-Schiff stain, ×200; left, Gomori methenamine silver stain, ×400).

Reference

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