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EW CATARACT 25 "I would counsel this patient accordingly and reassure him that the healing process will likely result in an acceptable level of acuity. As this is not an epidemic 'DLK' per se, no other changes to the surgical reg- imen (i.e., sterilization procedures) need to be altered." In treating this patient I first tried aggressive topical steroids every hour combined with systemic doxycycline, a methylprednisolone dose pack, and punctal occlusion, but found that it made no difference so I tapered the steroids down to my routine post-PRK regimen over a few weeks. What I found with frequent follow-up was that this patient was rapidly improving and functioning rather well without any special treat- ment. He seemed to be bothered less by this than I was. When he returned for his 3-month follow-up visit he was 20/20-2 OD and 20/20 OS uncorrect- ed and essentially plano. See Figures 5 and 6 for this slit lamp images at 3 months. Note the remarkable changes relative to the first OCT images. The corneal stroma no longer demonstrates as much thinning or haze, and there is less compensato- ry epithelial hyperplasia. These are remarkable changes and occurred very quickly. As Dr. Maloney first reported CTK after PRK, I sought out his thoughts on this case. Here are his comments: "This patient has bilat- eral central toxic keratopathy (CTK). CTK usually occurs after LASIK, but can occur after PRK, too. In our original description of 23 eyes with CTK, 1 4 of the eyes developed the condition after PRK. These 4 eyes had the typical appearance, illus- trated here, of a non-inflammatory, ground-glass haze in the central cornea, extending posteriorly into the stroma. Eyes with CTK usually develop a significant hyperopic shift. The OCT images on day 4 are illumi- nating. There is opacification almost to the level of Descemet's membrane and collapse of the central stroma with compensating epithelial hyper- plasia, offering an explanation for the hyperopic shift. We found that the corneal opacification resolves in 3–9 months, and the hyperopic shift diminishes. The 3-month OCT images illustrate this, with stromal thickening and decreased opacifica- tion. 1 Take-home points Fortunately this patient recovered very quickly and did extremely well. Had I known he was going to recov- er as he did, I would have not have suffered through sleepless nights worrying about what was going on here and how to treat it. I wanted to share this case so others might have a better awareness of central toxic keratopathy as an entity to keep in December 2014 their differential diagnosis when and if they see a case like this. It will be reassuring to physician and patient to know that aggressive treatment is neither required nor beneficial and given some time, the prognosis is generally excellent. EW Reference 1. Sonmez B, Maloney RK. Central toxic keratopathy: description of a syndrome in laser refractive surgery. Am J Ophthalmol 2007;143:420–7. Editors' note: Dr. Safran has no finan- cial interests related to this article. Contact information Safran: safran12@comcast.net