Pneumococcal keratitis at the flap interface after laser in situ keratomileusis

A 28-year-old woman had uneventful laser in situ keratomileusis in the right eye. Six days postoperatively, she reported ocular pain and a large corneal stromal infiltrate was observed at the flap interface. A second surgery including lifting and excising the flap and scraping the stromal bed was performed. Topical antibiotics were prescribed. A bacterial culture revealed Streptococcus pneumoniae. The keratitis responded well to topical vancomycin. Twelve days after the second surgery, the stromal infiltrate had regressed, the hypopyon had resolved, and visual acuity was hand movements at 0.5 m.