American Academy of Ophthalmology
In a recent article, Sonmez and Maloney describe a case series of 23 eyes of 14 patients with a post–refractive surgery syndrome characterized by noninflammatory central stromal opacification and hyperopic shift. The syndrome, which they call central toxic keratopathy, develops in the early postoperative period (days 3–6) after LASIK or PRK, usually following an episode of diffuse lamellar keratitis.
Clinically, the central opacification involves stroma deep to the interface in LASIK cases and is accompanied by thinning of the stroma, with the appearance of deep stromal folds and flap striae. A hyperopic shift also typically occurs. The syndrome is unresponsive to corticosteroids and, in most cases, resolves with time.
Of 19 eyes with pre- and postoperative best-corrected visual acuities available, only 1 lost 2 lines of vision. Seven eyes eventually underwent enhancement procedures with no recurrence of the syndrome. The cause of the syndrome is unknown, although the researchers hypothesize that the tissue loss may be related to keratocyte apoptosis.
REFERENCE
Sonmez B, Maloney RK. Central toxic keratopathy: description of a syndrome in laser refractive surgery. Am J Ophthalmol. 2007;143(3):420–427.