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PK Row, JC Affeldt, T LoBue; Lasik Related Stage III Neurotropic Keratitis . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2112.
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Purpose: Temporary loss of corneal sensation is a well recognized phenomena following a variety of excimer refractive procedures, and has been "presumably" associated with Stage I (punctate keratopathy) neurotropic keratitis. We document for the first time a case of Stage III (stromal melt) neurotropic keratitis following LASIK. Methods: A 34-Year-old Caucasian male underwent uncomplicated bilateral simultaneous LASIK for correction of -0.75 diopters of myopia. His past medical history was unremarkable, while his past ocular history and exam were significant for 2.5 years of prior soft contact lens wear, anterior blepharitis, and inferior limbal pannus; OS greater than OD (consistent with phlyctenular keratoconjunctivitis). Results: Bilateral diffuse punctate keratopathy was noted at post-op week one, with progression OS to an inferio-central epithelial defect by week three. Despite q-1 hour topical lubricants, inferior and superior collagen as well as Herrick lacrimal plugs, bandage contact lenses, and oral Salagen, the lesion progressed to a 1mm x 2 mm 90% depth clear stromal melt by week eleven. Central corneal sensation by Cochet-Bonnet esthesiometer was 12 mm OS, (verses 20 mm OD), but only 5 mm surrounding the melt zone. Viral culture and autoimmune workup were negative. NSAIDS were never utilized throughout the course. Following inferior thermal punctal occlusion, the lesion rapidly epithelized and filled, leaving a vascularized stromal facet. At one year post-op, the lesion remains stable, uncorrected vision is 20/20, while central corneal sensation remains depressed at 20 mm (verses 47 mm OD). Conclusion: Postoperative LASIK complications can include Stage I, II, or III neurotropic keratitis, with potential for corneal perforation if inadequately diagnosed and treated. Once properly identified however, the condition is rapidly responsive to thermal punctal occlusion, (as opposed to temporary or permanent lacrimal plugs). Preexisting corneal hypoesthesia secondary to stromal nerve damage from peripheral phlyctenular disease and/or previous contact lens wear may have been a contributing factor in this case.
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