Infectious Keratitis After Small-Incision Lenticule Extraction: First Reported Case From Turkey

ABSTRACT
Objective: To report the first documented case of infectious keratitis following small-incision lenticule extraction (SMILE) surgery in Türkiye. SMILE is a laser refractive procedure designed to correct refractive errors by creating a stromal lenticule with a femtosecond laser, which is then removed through a small incision.
Case: A 22-year-old male patient presented to our clinic with keratitis in the right eye, which developed 15 days after undergoing SMILE surgery. The patient reported severe pain, decreased vision, and sensitivity to light (photophobia) in the affected eye. Examination findings included conjunctival injection, diffuse corneal edema, and dense infiltrative lesions in both the central and paracentral cornea. Initial empirical therapy with fortified antibiotics was ineffective as the condition progressed, leading us to add antifungal agents to the treatment regimen.: Following the revised treatment approach, the patient experienced significant relief from symptoms, with a marked resolution of corneal edema and epithelial defects within one month. Although culture results from corneal scrapings were negative, the patient’s favorable response to antifungal treatment suggested a possible fungal etiology.
Conclusion: This case highlights the importance of considering fungal pathogens as potential culprits in culture-negative infectious keratitis following SMILE surgery. Prompt intervention and careful adjustment of empirical therapy play a critical role in managing similar cases effectively.
Keywords: Refractive surgery, small incision lenticule extraction, infectious keratitis