Late Onset Interface Calcium Deposition After Laser In Situ Keratomileusis

Abstract

The purpose of this study was to report a novel clinical entity characterized by bilateral calcium deposits in the flap interface after uncomplicated laser in situ keratomileusis (LASIK).Methods: Slit-lamp examination, anterior segment optical coherence tomography imaging, and histopathologic analysis of an interface opacity were performed to characterize and identify the origin of the interface opacities.Results: Two unrelated healthy young men who underwent LASIK in both eyes at 20 (case 1) and 44 (case 2) years of age were diagnosed with bilateral, white anterior stromal opacities 5 years after LASIK surgery. Slit-lamp examination and anterior segment optical coherence tomography imaging demonstrated that the opacities were located at the level of the LASIK interface in both eyes of both cases, with most of the opacities located at the temporal edge of the flap in each eye of case 2. An opacity from case 2 demonstrated birefringence using polarization microscopy and staining with Alizarin red, indicative of calcium deposition. The serum calcium level was borderline elevated in case 1 and within normal limits in case 2.Conclusions: Intrastromal calcium deposition can occur after LASIK surgery, with the deposits resembling dystrophic deposits located in the LASIK flap interface in individuals with granular corneal dystrophy type 2. Because the etiology and management of calcific and dystrophic interface deposition after LASIK are distinct, it is important for clinicians to differentiate the 2 entities based on the examination, diagnostic imaging, and, if necessary, molecular genetic analysis.

Bilateral post-LASIK exacerbation of granular corneal dystrophy with epithelial ingrowth

“…Additionally, epithelial ingrowth in the flap interface with connection to the surface corneal epithelium was evident on light microscopy; however, there was no evidence of intrastromal calcium deposition in the interface as has been previously described in one of the case reports by Chen et al in individuals with GCD type 2. The serum calcium levels were also borderline elevated in one of their cases with dystrophic calcium deposits 16…”

Bilateral post-LASIK exacerbation of granular corneal dystrophy with epithelial ingrowth

“…Additionally, epithelial ingrowth in the flap interface with connection to the surface corneal epithelium was evident on light microscopy; however, there was no evidence of intrastromal calcium deposition in the interface as has been previously described in one of the case reports by Chen et al in individuals with GCD type 2. The serum calcium levels were also borderline elevated in one of their cases with dystrophic calcium deposits 16…”

Bilateral post-LASIK exacerbation of granular corneal dystrophy with epithelial ingrowth

“…Additionally, epithelial ingrowth in the flap interface with connection to the surface corneal epithelium was evident on light microscopy; however, there was no evidence of intrastromal calcium deposition in the interface as has been previously described in one of the case reports by Chen et al in individuals with GCD type 2. The serum calcium levels were also borderline elevated in one of their cases with dystrophic calcium deposits 16…”

Bilateral post-LASIK exacerbation of granular corneal dystrophy with epithelial ingrowth

“…Additionally, epithelial ingrowth in the flap interface with connection to the surface corneal epithelium was evident on light microscopy; however, there was no evidence of intrastromal calcium deposition in the interface as has been previously described in one of the case reports by Chen et al in individuals with GCD type 2. The serum calcium levels were also borderline elevated in one of their cases with dystrophic calcium deposits 16…”