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Ophthalmic Images
September 13, 2018

A Surprise Guest—Insect Larva Under An Uncomplicated Laser-Assisted In Situ Keratomileusis Surgical Flap

Author Affiliations
  • 1Department of Ophthalmology, Hôpital Charles Nicolle, Boulevard Gambetta, Rouen, France
JAMA Ophthalmol. 2018;136(9):e183084. doi:10.1001/jamaophthalmol.2018.3084

A 23-year-old man with myopia underwent an uncomplicated laser-assisted in situ keratomileusis (LASIK) refractive surgery. Six days later, a slitlamp examination (Figure, A) revealed an asymptomatic insect larva under the right LASIK flap, localized at the upper periphery in the interface. This was demonstrated again by anterior segment optical coherence tomographic scanning (Figure, B). Because the patient’s visual acuity was 20/20 OU without inflammation, close clinical follow-up was chosen, and antibiotics and corticosteroid eyedrops were stopped at 2 weeks. The patient returned 15 days later because of a localized superior inflammatory reaction, with localized neovascularization in response to the insect larva; the larva had already partially disappeared. High-dose topical antibiotics and corticosteroids were initiated, and the patient was followed up weekly during the first month and then monthly. At 3 months, visual acuity had returned to 20/20 OU, and the insect had completely disappeared, leaving only a very small scar without neovascularization.