Central Focal Interface Opacity After Laser in situ Keratomileusis

Abstract

BACKGROUND: The acute onset of a focal central interface opacity with visual loss following LASIK has not been described in the peer reviewed literature. Non-peer reviewed reports of various inflammatory lesions have been recorded. METHODS: We describe three cases in which an acute focal stromal interface opacification was identified within 1 week of laser in situ keratomileusis (LASDX). Each case was performed by a different surgeon on a different day, but using the same method, materials, and the Summit Apex Plus excimer laser. Immediately after surgery, all eyes were normal with good unaided vision. The appearance of the central stromal opacity was associated with acute visual deterioration. Preoperative and postoperative cycloplegic refractions, videokeratography, and postoperative slit-lamp biomicroscopy were performed. Each case was treated with intensive topical corticosteroids. RESULTS: Each case demonstrated a central circular opacity in the interface between corneal flap and stromal bed, with associated variable stromal thinning. Resolution of the pathological process followed 2 to 4 weeks of treatment with topical corticosteroids and subsequent improvement in slitlamp biomicroscopy, corneal topography, and vision. Etiology was uncertain. CONCLUSION: Central interface opacification is a rare but visually important inflammatory complication of LASLK. [J Refract Surg 1998;14:571-576]

Central Toxic Keratopathy after Small Incision Lenticule Extraction

“…This corneal opacity and hyperopic shift characteristically persist for 2-18 months before resolving spontaneously. [5,10,11] In our patient's 1st-week follow-up, we observed that the prognosis improved by the opacification in the center decreased and the visual acuity level increased to 0.9. After about 1.5 months, we determined that the pathology had improved significantly, both in imaging methods and in our biomicroscopic examination with a visual acuity level of 1.0.…”

“…Although the cornea is transparent on the 1st day after surgery, central corneal opacification in CTK begins with an appearance similar to DLK on the 1st or 2nd postoperative day and rapidly causes intense opacification of the central corneal stroma. This corneal opacity and hyperopic shift characteristically persist for 2 – 18 months before resolving spontaneously 5 , 10 , 11 . In our patientʼs 1st-week follow-up, we observed that the prognosis improved as the opacification in the center decreased and the visual acuity level increased to 0.9.…”

“…Collectively, these findings further provide limited support regarding the role of steroids in the management of CTK. [7,11,12] Despite these controversial treatment recommendations, we thought that steroid treatment had a pronounced effect on recovery and we were able to get a good response to a potent steroid in a short time. Since washing the corneal interface in these patients would increase the pathology more, we never thought of interface washing.…”

Acute Foggy Corneal Epithelial Disease: Seeking Clinical Features and Risk Factors

“…CTK is initially described as a rare complication after LASIK surgery, mainly occurring within 9 days after refractive surgery, and patients may experience blurred vision, pain, photophobia, floaters, and foreign body sensation [ 27 , 28 , 29 ]. CTK presents as a central or peri-central amorphous corneal opacity with corneal striation, stroma thinning, and hyperopia shift.…”

Topical Minoxidil Solution-Induced Central Toxic Keratopathy following Photorefractive Keratectomy

“… 2 3 CTK was initially described in a case series after mechanical microkeratome-assisted laser in situ keratomileusis (LASIK) in 1998. 4 The incidence of CTK is rare and estimated to be 0.016% after refractive surgeries. 1 3 Several case studies claimed that the incidence of CTK is not exclusive to the mechanical microkeratome-assisted LASIK surgeries and has also developed after femtosecond LASIK, photorefractive keratectomy (PRK), trans-PRK, and small incision lenticule extraction surgeries.…”