Bilateral corneal perforation following post-PRK fungal keratitis managed with tenons patch graft

A woman in her early 20s underwent bilateral photorefractive keratectomy (PRK) for correction of myopia. She developed bilateral central corneal melt 3 weeks post-operatively. There was no response to oral antivirals (for presumed necrotising stromal keratitis) and oral steroids (for presumed immune-mediated melt). She gradually developed pigmented corneal infiltrates and microbiology revealed a fungal infection. Despite intensive antifungal therapy, she developed corneal perforations. After applying tissue adhesive as a temporary measure, she was referred for further management. Bilateral Tenon’s patch grafts (TPG) were performed and the infection resolved with antifungal therapy. Three months later, her vision improved to 20/40, which was maintained even at the 1-year follow-up.

Bilateral corneal melt following PRK is uncommon. A high index of suspicion is required to identify microbial keratitis as a potential cause, especially since sterile infiltrates are also known post-PRK. TPG serves as an effective option in such a situation.