Five-Year Occurrence and Management of Central Toxic Keratopathy After Femtosecond Laser–Assisted LASIK

Abstract

PURPOSE: To report the 5-year occurrence, management, and outcomes of 12 eyes diagnosed as having central toxic keratopathy (CTK) after femtosecond laser–assisted in situ keratomileusis (FS-LASIK). METHODS: A retrospective chart review was conducted on 20,622 FS-LASIK procedures performed at a single site from January 2015 to December 2019 to identify patients diagnosed as having central toxic keratopathy. Preoperative and postoperative visual acuity, refraction, and imaging were recorded and analyzed. RESULTS: CTK occurred in 12 eyes of 8 patients after FSLASIK. A total of 75% of eyes were diagnosed during an outbreak that happened over 2 months and the remaining 25% were considered sporadic. Five eyes were treated with flap lift and irrigation and 7 eyes were treated non-surgically. The average time to resolution of CTK in eyes that underwent flap lift and irrigation was 53 days compared to 33 days in eyes treated non-surgically. All 5 eyes treated with flap lift and irrigation ultimately achieved uncorrected distance visual acuity of 0.1 logMAR or better, whereas only 3 of 7 eyes treated non-surgically achieved the same. At the final postoperative visit, the eyes treated with flap lift and irrigation measured on average 14 µm thinner and 1.60 diopters (D) flatter than the expected postoperative pachymetry and keratometry, respectively. Those treated non-surgically were on average 28 µm thinner and 1.70 D flatter than expected. CONCLUSIONS: CTK is a rare complication of FS-LASIK but can occur in clusters. Although management of CTK is debated, flap lift and irrigation may lead to better visual acuity and refractive and anatomic outcomes in some cases. [ J Refract Surg . 2021;37(1):25–31.]

Central Toxic Keratopathy in Siblings After Laser-Assisted Keratomileusis: Case Report and Literature Review

“…5 In contrast to other studies that have described better visual outcomes with surgical management of CTK with flap lift and irrigation, our case demonstrates the possibility of rapid and full recovery with nonsurgical management. 23 With early supportive treatment, our patients achieved rapid improvement without significant prolonged corneal flattening or hyperopic change within 3 months, in contrast to some cases of CTK that have persisted up to 18 months in the literature.…”

Topical Minoxidil Solution-Induced Central Toxic Keratopathy following Photorefractive Keratectomy

“… 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. 3 5 6 7 8 The incidence of CTK after procedures other than LASIK suggests that in contrast to previous clinical belief, the pathophysiology could not be related to the flap formation. The exact etiology of CTK remains uncertain; however, different inciting pathogeneses have been proposed, including intraoperative meibomian gland secretions and photoactivation of povidone-iodine by the excimer laser.…”

“… 1 Recent publication on CTK suggests that in some cases, irrigation of the stromal bed under the flap after femtosecond LASIK can enhance the recovery time of CTK but not the final visual outcome and prognosis. 7 …”

Central toxic keratopathy after small incision lenticule extraction surgery:A case report

“…5 There is still insufficient clinical awareness on the disease, and early recognition and prompt treatment are essential. The etiology of CTK is unknown; it may occur within days after an uneventful LASIK or PRK, 3,7 corneal collagen cross-linking, 8 and overuse of contact lenses. 1 Besides, it has been reported after SMILE (there is only one case at present).…”