case_images: PMC9393015_01
case_images: A 19-year-old man with three dense round white infiltrates in the central cornea with cellular reaction in the right eye 5 days after SMILE (A). Oct-optic (cassia) examination of the right eye revealed that the central cornea was cloudy to the cap-stromal bed interface (B).
case_images: IDR-15-4585-g0001.jpg
case_images: PMC9393015_01_IDR-15-4585-g0001.jpg
case_images: f0001
case_images: Slit-lamp examination revealed 3 dense, round, white infiltrates at the central cap-stromal bed interface along with a cellular reaction (Figure 1A). Oct-optic (cassia) of the eye revealed that the central cornea was cloudy up to the cap-stromal bed interface (Figure 1B).
case_images: PMC9393015_02
case_images: A 23-year-old man with a paracentral white cross infiltrate at the corneal cap-stromal bed interface 3 days after SMILE in his left eye (A). At 1 month after the surgical intervention, the cornea has only a trace of a residual peripheral scar, and the vision improved to 20/20 (B).
case_images: IDR-15-4585-g0002.jpg
case_images: PMC9393015_02_IDR-15-4585-g0002.jpg
case_images: f0002
case_images: Slit-lamp examination revealed a paracentral, white, cross-shaped infiltrate at the corneal cap-stromal bed interface (Figure 2A). One month after the surgical intervention, the patient's UCVA was 20/20, and only a trace of a residual peripheral scar was present (Figure 2B).
case_images: PMC9393015_03
case_images: A 26-year-old man with a 1.5-mm  melt in the central anterior corneal cap with diffuse dense infiltration at the corneal cap-stromal bed interface, and multiple keratic precipitates in the left eye 3 days after SMILE (A). Smear examination shows Gram-positive cocci (B).
case_images: IDR-15-4585-g0003.jpg
case_images: PMC9393015_03_IDR-15-4585-g0003.jpg
case_images: f0003
case_images: We detected a 1.5x1.5mm2 melt in the central anterior corneal cap accompanied by diffuse dense infiltration at the corneal cap-stromal bed interface, and multiple keratic precipitates in the left eye (Figure 3A). The smear examination showed Gram-positive cocci (Figure 3B), and a diagnosis of bacterial keratitis after SMILE in the left eye was made.
case_images: PMC9393015_04
case_images: An 18-year-old man with several dense white satellite infiltrates of different sizes at the corneal cap-stromal bed interface, corneal edema, and endothelial immune rings 4 days after SMILE in both eyes [A(R) B(L)]. The following day, after scraping of the lesions near the original incision and interface irrigation, there is less infiltration near the incision, but increased infiltration in both eyes [C(R) D(L)]. After the incision was enlarged to about 2 quadrants, and the corneal cap was opened to fully scrape the necrotic tissue and thoroughly rinse the lesion; the infection was controlled, with significant reduction in pain and photophobia over the next 48 hours [E(R) F(L)]. At 1 year after onset, the cornea has a resolving scar, and the vision improved from hand motions to 20/32 in the right eye and 20/25 in the left eye [G(R) H(L)].
case_images: IDR-15-4585-g0004.jpg
case_images: PMC9393015_04_IDR-15-4585-g0004.jpg
case_images: f0004
case_images: Slit-lamp examination revealed several dense, white multiple infiltrates of differing sizes at the interface between the corneal cap and stromal bed, along with corneal edema and immune rings on the corneal endothelium (Figure 4A and B). On the next day after this operation, the infiltrates near the incision areas had decreased, but the infiltrates in the central part of the cornea had increased and those in the right eye had become more obvious (Figure 4C and D). On day 7 of the corneal infection, the patient reported a considerable decrease in pain and photophobia (Figure 4E and F), so the systemic antibiotics were discontinued. At 1 year after the last procedure, the corneal showed residual stromal scarring (Figure 4G and H), and the UCVA improved to 20/32 and 20/25 in the right and left eyes, respectively.
case_images: PMC9393015_05
case_images: An 18-year-old man with several dense white infiltrates in the central cornea 4 days after SMILE in the right eye, and the infiltrates were more serious than before (A). The left eye showed multiple white infiltrates at the corneal cap-stromal bed interface (B). At 5 days after SMILE, the incision was enlarged to more than 2 quadrants, and the corneal cap was opened to fully scrape the infiltrates and rinse with antibiotics. The right eye improved 2 days later (C), but as the infiltrates worsened in the left eye (D), irrigation of the corneal cap-stromal bed interface in the left eye was repeated. At 6 months after the onset, the cornea has residual stromal scarring, and the vision improved from light perception to 20/25 in the right eye (E) and 20/32 in the left eye (F).
case_images: IDR-15-4585-g0005.jpg
case_images: PMC9393015_05_IDR-15-4585-g0005.jpg
case_images: f0005
case_images: Slit-lamp examination revealed round, white infiltrates involving the central corneal cap and the underlying stromal bed that had increased in severity since their onset in the right eye (Figure 5A). Multiple white infiltrates in the mid-peripheral area and diffuse cell infiltration at the corneal cap-stromal bed interface were observed in the left eye (Figure 5B). Two days later, the right eye improved (Figure 5C). Unfortunately, the infiltrates in the left eye were not under control (Figure 5D). Slit-lamp examination showed residual stromal scarring (Figure 5E and F).