Salzmann nodular degeneration associated with epithelial ingrowth after LASIK treated with superficial keratectomy

Abstract

SUMMARYA 41-year-old woman who underwent uncomplicated LASIK and two subsequent flap lifts for epithelial ingrowth of the right eye became progressively symptomatic with blurred vision, photophobia and foreign body sensation over the ensuing 5 years. Clinical examination of the right eye demonstrated extensive epithelial ingrowth around the flap periphery with overlying Salzmann nodules in the same distribution. Similar findings were not present in the left eye. Anterior segment optical coherence tomography demonstrated subclinical flap elevation in the areas of epithelial ingrowth, which may have predisposed to nodule development due to a dellen effect. The patient underwent superficial keratectomy with significant improvement of her symptoms. BACKGROUND

Superficial keratectomy for Salzmann nodular degeneration following laser in situ keratomileusis

“…[2][3][4] Only 1, reported by Stem et al, was treated with superficial keratectomy, because the nodule showed extensive involvement around the entire flap circumference. 6 Similarly, the 3 treatment-resistant cases in this report had symptomatic resolution and vision restoration to 20/20 by 1 month after superficial keratectomy. With standard post-operative treatment of antibiotics and topical steroids, no post-procedural complications were reported.…”

“…[2][3][4][5] While many responded with ocular lubrication and lid hygiene management, the disease progresses despite treatment in a small fraction of patients. 6 This case series reports successful surgical management (superficial keratectomy) of 3 cases of early-onset Salzmann nodules involving the LASIK flap edge.…”

“…DMEK was then performed similar to what has been previously described in the literature. 6 The graft was prestripped and marked with an "S" by the local eye bank (Hema-Quebec, Montreal, Que.). No inferior iridotomy was performed in this case.…”

<p>Salzmann nodular degeneration: prevalence, impact, and management strategies</p>

“…Development of SND after LASIK has been reported multiple times 9,27–29. Given the presentations of SND both proximal and remote from the LASIK history, the trigger for post-LASIK SND may be surgical trauma, anatomical disruption in the area of the flap, and/or post-operative dry eye disease 9,27–29. In one case, an individual presented eight months after LASIK complaining of blurry vision and a small growth on the cornea was noted.…”

“…Six months after her initial presentation, her symptoms had resolved, and uncorrected visual acuity improved from 20/50 to 20/20 in the right eye and 20/30 −1 to 20/30 +1 correctable to 20/20 in the left eye 9. While post-LASIK SND is commonly treated medically, superficial keratectomy has been used to treat concomitant peripheral epithelial ingrowth and overlying SND in the setting of LASIK 29…”