EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/422211
I was familiar with central toxic keratopathy occurring after LASIK but was unaware that it could occur after PRK. Dr. Majmudar shared his thoughts: "This type of occurrence is possibly the worst nightmare for refractive surgeon and patient alike, as it occurs after routine elective refractive surgery, and there may not be much that we can do to ameliorate the symptoms. Fortu- nately, 'tincture of time' heals most wounds, including this one. Based on the information supplied, this is a young male patient who underwent routine PRK surgery in both eyes. The preop evaluation was unremarkable, and the intraop course was routine in ev- ery way. However, 4 days following PRK the patient presented with bilat- eral corneal opacity and thinning. "The first inclination with this type of presentation after PRK is to rule out infectious etiology. As there was no significant infiltrate per se, cultures may not be able to be per- formed, but had this been a LASIK case, I would have lifted the flap and obtained cultures for bacteria and atypical organisms. Most bacterial infections would present with more symptomatology (i.e., red eye, pain, etc.), while fungal or atypical organ- isms would typically present with a more indolent course (i.e., not at 4 days post-surgery). "When thinking about a post- LASIK case, DLK comes to mind. However in this case there was no interface. Nonetheless, central toxic keratopathy (CTK) must be included in the differential. CTK differs from DLK in that it involves (in a LASIK case) more than the interface—it involves the flap and the stroma be- low. It does not respond to steroids unlike DLK, and it has been reported in PRK. It is truly an enigma. Having treated several cases (all post-LASIK), I have been relegated to a lot of 'hand holding' and reassurance, but in my limited experience (n=3), each of these cases returned to 20/20 uncorrected acuity—although it took approximately 1 year to achieve stabilization. Expanding opportunities When PRK continued from page 22 Figures 7 and 8. Follow-up OCT images taken the same day Source (all): Steven G. Safran, MD Figures 5 and 6. OD and OS at 3 months. Note marked improvement in cornea clarity from day 4 postop.