Fungal Interface Keratitis Following Superficial Anterior Lamellar Keratectomy for Limbal Dermoids

Purpose To describe the occurrence, clinical presentation, and management of delayed-onset fungal infectious interface keratitis (IIK) following superficial anterior lamellar keratectomy (SALK) performed for limbal and sclerocorneal dermoid excision. Methods Case series. Results Two pediatric patients who underwent SALK for limbal or sclerocorneal dermoids developed delayed-onset graft infiltration several weeks after surgery. Both patients initially presented with interface haze and infiltrates and were treated with intensive topical fortified antibacterial therapy, with no clinical improvement. Initial microbiological evaluation was non-contributory in both cases. Subsequent graft removal was performed due to refractory clinical course, and repeat microbiological evaluation from the host bed revealed fungal filaments on 10% potassium hydroxide staining with culture positivity. Targeted antifungal therapy was initiated, resulting in resolution of infection in both cases. At final follow-up, the cornea healed with minimal peripheral scarring, and useful visual acuity was preserved in both patients. Conclusions Fungal IIK can occur as a delayed postoperative complication following SALK. Diagnosis may be delayed due to subtle clinical findings and initially negative microbiological results. Early consideration of fungal infection, prompt graft removal in medically unresponsive cases, and initiation of appropriate antifungal therapy are critical for favorable anatomical and visual outcomes. To the best of our knowledge, this represents the first reported case series of fungal IIK following SALK performed for dermoid excision.