Late-onset corneal haze after intrastromal corneal ring implantation in an eye with previous topography-guided PRK.

PURPOSE: To report a case of late-onset corneal haze 3 months after intrastromal corneal ring segment (ICRS) implantation in an eye with previous transepithelial topography-guided photorefractive keratectomy (TG-PRK). OBSERVATIONS: A 40-year-old woman with stable keratoconus for 10 years underwent limited TG-PRK with mitomycin C in both eyes for mixed astigmatism. After four years, with atopic symptoms worsening and eye rubbing, the patient presented keratoconus progression in the left eye with increased irregular astigmatism. An ICRS was implanted with initial improvement in vision. Three months later severe subepithelial haze was observed along the ring groove. CONCLUSION AND IMPORTANCE: This is the first report of subepithelial haze after ICRS implantation. This report increases the evidence that permanent corneal wound healing changes occur after PRK and that late-onset haze may be triggered by corneal remodeling, as little inflammation or epithelial defect occurs after ICRS implantation. We do believe the detection of triggers, identification of risk factors of late-onset haze and appropriate preoperative counselling have an increasing importance due to the rising number of patients that have undergone PRK.

Focal phototherapeutic keratectomy for the treatment of apical leucoma syndrome / PTK focal para o tratamento da síndrome do leucoma apical

ABSTRACT The following report describes a case of apical leucoma syndrome after hyperopic photorefractive keratectomy following hyperopic laser in situ keratomileusis and the subsequent treatment of this complication with focal phototherapeutic keratectomy. The patient underwent focal transepithelial phototherapeutic keratectomy of 70 mm ablation and 1.5 mm diameter after pupil and ablation offset correction. After 1 year, significant improvement in vision was observed and only slight residual opacity remained on biomicroscopy and optical coherence tomography. Focal phototherapeutic keratectomy was effective and safe for the treatment of this complication.

RESUMO O relato a seguir descreve um caso da síndrome do Leucoma Apical após cirurgia ceratorrefrativa hipermetrópica depois de Laser hiperópico in situ keratomileusis, e o subsequente tratamento desta complicação com ceratectomia fototerapêutica focal. O paciente foi submetido à ceratectomia fototerapêutica focal transepitelial com ablação de 70 mm e diâmetro de 1,5 mm, após correção de offset pupilar. Depois de um ano, foi observada uma melhora significativa da acuidade visual permanecendo apenas leve opacidade residual na biomicroscopia e tomografia de coerência óptica. A ceratectomia fototerapêutica focal foi efetiva e segura para o tratamento desta complicação.

Focal phototherapeutic keratectomy for the treatment of apical leucoma syndrome.

The following report describes a case of apical leucoma syndrome after hyperopic photorefractive keratectomy following hyperopic laser in situ keratomileusis and the subsequent treatment of this complication with focal phototherapeutic keratectomy. The patient underwent focal transepithelial phototherapeutic keratectomy of 70 mm ablation and 1.5 mm diameter after pupil and ablation offset correction. After 1 year, significant improvement in vision was observed and only slight residual opacity remained on biomicroscopy and optical coherence tomography. Focal phototherapeutic keratectomy was effective and safe for the treatment of this complication.

Photorefractive Keratectomy With Mitomycin C in Meesmann's Epithelial Corneal Dystrophy.

PURPOSE: To describe a case of Meesmann's epithelial corneal dystrophy that underwent photorefractive keratectomy (PRK) with mitomycin C. METHODS: Case report. RESULTS: A 36-year-old woman was evaluated for refractive surgery. She had a history of recurrent epithelial erosions and moderate visual loss over the past 10 years. Biomicroscopy revealed bilateral micro-cystic epithelial lesions and a diagnosis of Meesmann's epithelial corneal dystrophy was proposed. Corneal optical coherence tomography showed epithelial thickening with apparent intraepithelial cysts in the superficial layers. The patient's daughter's examination showed the same biomicroscopy pattern. PRK was performed. Epithelial healing was uneventful and only tiny microcysts could be observed after 3 months. However, complete recurrence of the intraepithelial cysts were observed after 1 year with visual acuity dropping due to residual refractive error. CONCLUSIONS: This case suggests that residual refractive error and recurrence of the cystic lesions and punctate erosions should be anticipated after PRK in patients with Meesmann's epithelial corneal dystrophy. [J Refract Surg. 2017;33(1):53-55.].