We report the use of the femtosecond laser (IntraLase FS laser; Advanced Medical Optics, Inc, Santa Ana, Calif) to create a therapeutic lamellar keratectomy to facilitate the treatment of fungal keratitis. Lamellar keratectomy was used to remove infected tissue and more importantly to enhance penetration of topical antifungal medication in our patient with an aggressive Paecilomyces keratitis infection.
The femtosecond laser (IntraLase) was used to create a 6-mm-diameter flap, which was converted to a cap with a thickness of 100 μm. The cap was then removed, exposing the infected stromal bed. Voriconazole, amphotericin, chlorhexidine, and polyhexamethylene biguanide, 1 drop each, were applied directly to the exposed stromal bed. Antifungal medication was continued while the patient's symptoms improved, visual acuity increased, and the corneal infiltrate became less prominent. After several months of steady improvement, antifungal medications were tapered. At that time, the patient displayed evidence of a flare-up of the infection. Penetrating keratoplasty was performed without complication, and the infection did not recur after the corneal transplant. Femtosecond laser may be useful in the treatment of advanced fungal keratitis.