Central toxic keratopathy: a clinical case series

Abstract

The CTK clinical findings are well described, but with a yet unknown origin. It seems clear that it does not require specific treatment. It is possible that there might be a relationship between a substance of the gloves and CTK. Further studies are needed to know all the details of this process.

Bilateral central toxic keratopathy after laser in situ keratomileusis

“…With these findings and our literature review of all available publications on CTK, the most effective management for CTK thus far is close-monitoring 2 4 8 12 14 15. Numerous studies and case series have proven that corneal opacification in CTK clears within 18 months without intervention or treatment 4 12.…”

“…Anterior segment optical coherence tomography images have suggested that the rate of tissue apoptosis slowed as early as 1 week post-LASIK, with a rapid increase in corneal thickness at 5 weeks, due to the proliferation of keratocytes 4 12. This correlates with the cessation of postoperative topical steroids.…”

Central toxic keratopathy: a clinical case series

“…We read with great interest the article by Marí Cotino and associates1 about an epidemic of central toxic keratopathy (CTK) that occurred after laser in situ keratomileusis (LASIK), presumably caused by the change of the brand of the surgical gloves. Although its aetiology is unknown, CTK has common features with grade IV diffuse lamellar keratitis, but it is widely accepted that it represents a separate clinical entity.…”

“…Marí Cotino et al 1 state in their article that CTK does not have a specific treatment and that the clinician must wait for a spontaneous improvement which is expected to occur in most cases in the short to long term. However, it has been reported that a spontaneous visual improvement does not always happen in severe CTK cases 2.…”

Authors’ response: Central toxic keratopathy: a clinical case series

“…Some authors like Hainline4 and colleagues found no differences between expectant treatment or washing the interface, while an article written by Lyle and Jin,10 and another one by You and Asianides,11 support the lifting of the flap and washing of the interface as a valid treatment. We have had a case in which we had to lift the flap and irrigate the interface due to a lenticule displacement; the recovery in the mentioned eye was faster in contrast with the other eye of the same patient which didn't receive the same procedure,12 perhaps indicating that early lifting of the flap and irrigation of the stromal bed may mitigate the severity of this complication.…”