Bilateral Peripheral Infiltrative Keratitis After LASIK

Abstract

PurposeTo present a case of peripheral infiltrative keratitis mimicking infectious keratitis on the flap margin and limbus, which appeared on the first postoperative day after the laser in situ keratomileusis (LASIK).MethodsA 36-year-old woman who underwent uneventful bilateral simultaneous LASIK developed multiple round infiltrate along the flap margin reaching to limbus from the 11 o'clock to 6 o'clock area in both eyes.ResultsThe flap was lifted and irrigation was performed with antibiotics. but infiltration seemed to appear again. The infiltrate was more concentrated at the periphery and was extended to the limbus. Direct smear and culture for bacteria and fungus were negative. Topical prednisolone acetate 1% eye drops was added, infiltrative condition was resolved.ConclusionsLASIK induced peripheral infiltrative keratitis, in which infectious origin was ruled out, is reported

Idiopathic peripheral necrotizing keratitis after femtosecond laser in situ keratomileusis

“…Several authors cite the prompt response to topical steroids as a defining aspect of peripheral sterile keratitis, which differs from the patient presented in our case. 2,6 The infiltrates in the patient we report worsened despite intensive topical application of prednisolone acetate 1% hourly but responded dramatically once oral prednisone was initiated. In 2 of the 3 cases reported by Lifshitz et al, 1 oral steroids were administered and tapered over 2 weeks with good response.…”

“…Several findings favor an immunologic etiology over infectious keratitis and may defer corneal scrapings pending results of treatment: bilateral infiltrates at the periphery, a circumferential ring pattern, intact overlying epithelium, absence of conjunctival injection or ciliary flush, and absence of discharge or anterior chamber reaction. 1,2,6 Because of these findings in our patient, an infectious etiology was determined to be unlikely and the flap was not lifted for irrigation and culture.…”

Sterile corneal infiltrates after corneal collagen cross‐linking: evaluation of risk factors

“…; Moon et al. ; Bucci & McCormick ), laser epithelial keratomileusis (LASEK; Tabery ) and photorefractive keratectomy (PRK; Karr et al. ; Geggel ).…”

Paracentral sterile ring infiltrate after corneal crosslinking in a child

“…An immune response triggered by contact lenses, epithelial damage, UV-A irradiation, individual's hypersensitivity, and nonsteroidal anti-inflammatory drugs may be responsible for the formation of sterile infiltrates. 2,[5][6][7][8][9][10] However, none of these mechanisms alone is sufficient to explain the pathophysiology. 8,10 Enhanced cell-mediated immunity to staphylococcal antigens in areas of static tear pooling under the bandage contact lens causes sterile infiltrates.…”