{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T12:46:42Z","timestamp":1782996402107,"version":"3.54.5"},"reference-count":28,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,6,19]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>A woman in her early 20s underwent bilateral photorefractive keratectomy (PRK) for correction of myopia. She developed bilateral central corneal melt 3\u2009weeks 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\u2019s 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.<\/jats:p>\n                  <jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2025-267459","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T12:05:38Z","timestamp":1782993938000},"page":"e267459","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Bilateral corneal perforation following post-PRK fungal keratitis managed with tenons patch graft"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4824-5501","authenticated-orcid":false,"given":"Prajakta","family":"Dandekar","sequence":"first","affiliation":[{"name":"Cornea and Anterior Segment Service, Shantilal Shanghvi Eye Institute, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suresh","family":"Palanisamy","sequence":"additional","affiliation":[{"name":"Ophthalmology, Fortis Hospital Mulund, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maneck D","family":"Nicholson","sequence":"additional","affiliation":[{"name":"Cataract and Refractive Service, Shantilal Shanghvi Eye Institute, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8696-9669","authenticated-orcid":false,"given":"Somasheila I","family":"Murthy","sequence":"additional","affiliation":[{"name":"Cornea and Anterior Segment Service, Shantilal Shanghvi Eye Institute, Mumbai, Maharashtra, India"},{"name":"Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"2026070205053163000_19.7.e267459.1","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2014-306459"},{"key":"2026070205053163000_19.7.e267459.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.optom.2014.09.001"},{"key":"2026070205053163000_19.7.e267459.3","doi-asserted-by":"crossref","first-page":"2813","DOI":"10.4103\/ijo.IJO_2479_20","article-title":"Keratitis following laser refractive surgery: Clinical spectrum, prevention and management","volume":"68","author":"Das","year":"2020","journal-title":"Indian J Ophthalmol"},{"key":"2026070205053163000_19.7.e267459.4","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1038\/s41433-022-02009-2","article-title":"Post photorefractive keratectomy (PRK) infectious keratitis; six-year experience of a tertiary eye hospital","volume":"37","author":"Soleimani","year":"2023","journal-title":"Eye (Lond)"},{"key":"2026070205053163000_19.7.e267459.5","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/S0886-3350(02)02014-X","article-title":"Herpes simplex keratitis after photorefractive keratectomy","volume":"29","author":"Nagy","year":"2003","journal-title":"J Cataract Refract Surg"},{"key":"2026070205053163000_19.7.e267459.6","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0b013e318199e9cc"},{"key":"2026070205053163000_19.7.e267459.7","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1097\/01.ico.0000179931.05275.dd","article-title":"Corneal ulceration and perforation with ketorolac tromethamine (Acular) use after PRK","volume":"25","author":"Mian","year":"2006","journal-title":"Cornea"},{"key":"2026070205053163000_19.7.e267459.8","doi-asserted-by":"crossref","first-page":"35","DOI":"10.37685\/uiwlibraries.2575-7712.6.1.1022","article-title":"Herpes Simplex Keratitis after PRK","volume":"6","author":"Graf","year":"2024","journal-title":"OCP"},{"key":"2026070205053163000_19.7.e267459.9","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/j.jcrs.2006.11.005","article-title":"Infectious and noninfectious keratitis after laser in situ keratomileusis Occurrence, management, and visual outcomes","volume":"33","author":"Moshirfar","year":"2007","journal-title":"J Cataract Refract Surg"},{"key":"2026070205053163000_19.7.e267459.10","doi-asserted-by":"crossref","DOI":"10.3390\/jcm10061178","article-title":"Topical Corticosteroids and Fungal Keratitis: A Review of the Literature and Case Series","volume":"10","author":"Knutsson","year":"2021","journal-title":"J Clin Med"},{"key":"2026070205053163000_19.7.e267459.11","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1016\/S0886-3350(00)00468-5","article-title":"Diffuse lamellar keratitis: Diagnosis and management","volume":"26","author":"Linebarger","year":"2000","journal-title":"Journal of Cataract & Refractive Surgery"},{"key":"2026070205053163000_19.7.e267459.12","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1016\/j.ijscr.2020.12.051","article-title":"Bipolaris keratitis following photorefractive keratectomy: Case report","volume":"78","author":"AlBathi","year":"2021","journal-title":"Int J Surg Case Rep"},{"key":"2026070205053163000_19.7.e267459.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2011.04.037"},{"key":"2026070205053163000_19.7.e267459.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2005.09.038"},{"key":"2026070205053163000_19.7.e267459.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2005.07.032"},{"key":"2026070205053163000_19.7.e267459.16","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jtos.2021.12.001","article-title":"Fungal keratitis: A review of clinical presentations, treatment strategies and outcomes","volume":"24","author":"Sharma","year":"2022","journal-title":"Ocul Surf"},{"key":"2026070205053163000_19.7.e267459.17","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1097\/APO.0000000000000035","article-title":"Topical 5% Natamycin With Oral Ketoconazole in Filamentous Fungal Keratitis: A Randomized Controlled Trial","volume":"4","author":"Rajaraman","year":"2015","journal-title":"Asia Pac J Ophthalmol (Phila)"},{"key":"2026070205053163000_19.7.e267459.18","doi-asserted-by":"crossref","DOI":"10.3390\/microorganisms12010161","article-title":"Recent Advances in Diagnosis and Treatment Approaches in Fungal Keratitis: A Narrative Review","volume":"12","author":"Ghenciu","year":"2024","journal-title":"Microorganisms"},{"key":"2026070205053163000_19.7.e267459.19","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/S0161-6420(91)32211-5","article-title":"Use of corticosteroids in combination with antimicrobial drugs in the treatment of infectious corneal disease","volume":"98","author":"Stern","year":"1991","journal-title":"Ophthalmology"},{"key":"2026070205053163000_19.7.e267459.20","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1097\/ICL.0000000000000996","article-title":"Infectious Keratitis After Keratorefractive Surgery: Update and Review of the Literature","volume":"49","author":"Liu","year":"2023","journal-title":"Eye Contact Lens"},{"key":"2026070205053163000_19.7.e267459.21","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s12348-025-00452-2","article-title":"Infectious keratitis following photorefractive keratectomy: a 13-year study at a tertiary center","volume":"15","author":"Attar","year":"2025","journal-title":"J Ophthalmic Inflamm Infect"},{"key":"2026070205053163000_19.7.e267459.22","first-page":"9021","article-title":"Infectious keratitis: an update on the prevalence, risk factors, culture results, clinical features, visual outcomes, and therapeutic strategies of infectious keratitis","volume":"26","author":"Ojaghi","year":"2022","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"2026070205053163000_19.7.e267459.23","doi-asserted-by":"crossref","first-page":"110273","DOI":"10.1016\/j.intimp.2023.110273","article-title":"The use of orthokine therapy for the treatment of post refractive surgery corneal ulcer, a case report","volume":"120","author":"Mansouri","year":"2023","journal-title":"Int Immunopharmacol"},{"key":"2026070205053163000_19.7.e267459.24","doi-asserted-by":"crossref","first-page":"312","DOI":"10.3928\/1081-597X-20070301-18","article-title":"Bilateral bacterial keratitis in three patients following photorefractive keratectomy","volume":"23","author":"Karimian","year":"2007","journal-title":"J Refract Surg"},{"key":"2026070205053163000_19.7.e267459.25","doi-asserted-by":"publisher","DOI":"10.1097\/01.ICL.0000072826.38354.31"},{"key":"2026070205053163000_19.7.e267459.26","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1080\/08820538.2021.2017470","article-title":"Tenon\u2019s Patch Graft: A Review of Indications, Surgical Technique, Outcomes and Complications","volume":"37","author":"Kate","year":"2022","journal-title":"Semin Ophthalmol"},{"key":"2026070205053163000_19.7.e267459.27","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2020-238970","article-title":"Autologous tenon plug and patch in phacoburn","volume":"14","author":"Mansour","year":"2021","journal-title":"BMJ Case Rep"},{"key":"2026070205053163000_19.7.e267459.28","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1097\/ICO.0000000000003834","article-title":"Outcomes of a Tenon Patch Graft for Corneal Perforations in Resolving Infectious Keratitis","volume":"45","author":"Heroor","year":"2026","journal-title":"Cornea"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-267459","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T12:05:41Z","timestamp":1782993941000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-267459"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":28,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,2]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bcr-2025-267459"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-267459","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}