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Peter Lipscomb, Andrew E Holzman; Post-surgical immune keratitis after laser vision correction. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4875.
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© ARVO (1962-2015); The Authors (2016-present)
Peripheral keratitis after laser vision correction, distinct from diffuse lamellar keratitis, is a rare entity that has been described in the literature. With our case series we seek to further describe this rare but significant complication and provide insight into risk factors, treatment options and preventive measures for these patients. We believe our series to be the largest of such reported cases.
In our busy refractive surgery practice we reviewed charts and identified 13 patients (23 eyes) in our last 30,000 cases, between 2007 and 2015, who developed peripheral corneal infiltrates after undergoing laser vision correction.
Laser in-situ keratomileusis (LASIK) was performed in 18 eyes and photorefractive keratectomy (PRK) in 5 eyes. Ten patients had bilateral disease and 3 had unilateral. Eleven patients (83%) had a systemic pro-inflammatory condition and 5 patients (42%) had an ocular pre-disposition.In all cases the infiltrates were peripheral, circumferential along the wound edge, and separated from the limbus with an area of clear cornea. There was overlying loose epithelium and corneal thinning.All patients were treated with low dose topical steroid until the corneal thinning resolved and the surface improved. Topical antibiotics were given for coverage. Patients were treated oral prednisone on a tapered dose, which led to regression of the infiltrates. No patients suffered loss of best-corrected distance visual acuity and 83% of eyes achieved 20/20 snellen uncorrected distance acuity.
The bilateral tendency, worsening with antibiotics, location along the wound edge, and improvement with oral steroids yielded low suspicion for bacterial infection. While the etiology is unknown, in our series there was a strong association with systemic pro-inflammatory conditions such as atopy, hypothyroidism, and psoriasis suggesting a possible immunologic nature. We suspect these factors are even more important if underlying meibomian gland dysfunction, blepharitis, or rosacea is also present. We recommend these at-risk patients be pre-treated with oral steroid in an attempt to prevent disease occurrence. A high degree of suspicion for infectious etiology must be maintained. When treated appropriately with oral steroid visual outcomes are excellent. There is, however, significant risk of complication if not recognized early.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Figure 1: Infiltrates along the wound edge on day 3 following LASIK
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