Nepafenac-associated Bilateral Corneal Melt After Photorefractive Keratectomy

Feiz, Vahid; Oberg, Thomas J.; Kurz, C; Mamalis, Nick; Moshirfar, Majid

doi:10.1097/ico.0b013e318199e9cc

Cited by 28 publications

(24 citation statements)

References 11 publications

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“…Nepafenac-induced corneal graft melt was reported in one case with graft-versus-host disease [12], and nepafenac-associated bilateral corneal melt was reported in one case where nepafenac was used in error every 2 h [13]. Our patient and a previously reported patient treated with nepafenac had no corneal complications, but in patients with ICE who have malfunctioning endothelial cells, we have to be very careful about use of NSAIDs.…”

Section: Discussionmentioning

confidence: 69%

Cystoid macular edema associated with iridocorneal endothelial syndrome: a case report

et al. 2016

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BackgroundIridocorneal endothelial (ICE) syndrome occurs mainly in young and middle-aged women and typically presents as a unilateral disease characterized by abnormalities of the iris and corneal endothelium. While the ICE syndrome is known to be associated with glaucoma and bullous keratopathy, to our knowledge, only two cases of ICE syndrome complicated with cystoid macular edema (CME) have been reported to date. In this paper, we report a case of ICE syndrome complicated with CME treated at our institution.Case presentationThe subject was a 51-year-old woman. In October 2013, she was examined by a primary care physician for blurred vision in her left eye. Dyscoria and abnormality of the corneal endothelium were observed, and the patient was diagnosed with ICE syndrome. In November of the same year, she was referred to our institution with a decrease in visual acuity and CME, both in her left eye. At initial examination, her best corrected decimal visual acuity was 1.0 (Snellen equivalent: 20/20) in the right eye and 0.5 (20/40) in the left eye. Intraocular pressure was 12 mmHg in both eyes. She was diagnosed with Cogan–Reese syndrome based on marked ectropion uveae, peripheral anterior synechia, and abnormalities of the corneal endothelium. Marked CME was observed on ophthalmoscopy and optical coherence tomography. A topical non-steroidal anti-inflammatory drug (nepafenac 0.1 %) was applied to the left eye four times daily from January 2014. Four weeks later, the CME had resolved and her visual acuity was 1.0 (20/20).ConclusionWhile non-steroidal anti-inflammatory drugs and steroids did not appear to be effective in two previously reported cases of ICE syndrome complicated with CME, topical nepafenac was effective in this case. However, more such cases are needed before concluding that topical nepafenac is effective in this situation.

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Section: Discussionmentioning

confidence: 69%

Cystoid macular edema associated with iridocorneal endothelial syndrome: a case report

et al. 2016

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“…The relative incidence of corneal melt across the wider ophthalmic community following refractive or cataract surgery is difficult, if not impossible, to quantify accurately. Reports in the published literature are often small series or case reports outlining a single incidence . Undoubtedly a large number of episodes also remain unreported.…”

Section: Incidence Of Keratolysis Post‐refractive Surgerymentioning

confidence: 99%

“…More aggressive cases of corneal melting have also been reported. Feiz and colleagues reported a case of a patient who developed stromal melting in both eyes at four days after photorefractive keratectomy (PRK). This was believed to be associated with frequent post‐operative dosing of nepafenac, a non‐steroidal anti‐inflammatory drug (NSAID).…”

Section: Incidence Of Keratolysis Post‐refractive Surgerymentioning

confidence: 99%

A review of corneal melting following kerato‐refractive surgery

Hodge

Chan

Bali

et al. 2013

Clinical and Experimental Optometry

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“…However, NSAIDs must be used with caution as topical nepafenac is reported for corneal melt after PRK. [96] Once the defect heals and BCL is removed, topical corticosteroids such as Fluorometholone alcohol must be given four times daily, tapered by one drop per week, over a month. Topical lubricants are prescribed for a month, four to six times daily.…”

Section: Post Phototherapeutic Keratectomy Managementmentioning

confidence: 99%

Phototherapeutic keratectomy

Rathi

Vyas

Sangwan

2012

Indian J Ophthalmol

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Phototherapeutic keratectomy (PTK) is done regularly for anterior corneal diseases such as corneal dystrophies, corneal degenerations, scars, and band-shaped keratopathy. The various indications include both therapeutic and visual. The aim of this article is to discuss the therapeutic indications for PTK, the specific technique pertaining to a specific etiology, the various other procedures like amniotic membrane graft combined with PTK or PTK being done for recurrences in the grafts, and PTK done before cataract surgery when the anterior corneal pathology coexists with the cataract. Post PTK management such as healing of an epithelial defect, use of steroids in the post PTK period, recurrences of primary disease pathology, and infections, will be discussed. Methods of literature search: A Medline search was carried out for articles in the English language, with the keywords, phototherapeutic keratectomy, band-shaped keratopathy, spheroidal degeneration, scars, bullous keratopathy, and corneal dystrophy. The relevant references are mentioned here.

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Nepafenac-associated Bilateral Corneal Melt After Photorefractive Keratectomy

Abstract: We report a case of sterile ulceration after photorefractive keratectomy surgery, which we believe was caused by frequent postoperative dosing of nepafenac.

Cited by 28 publications

References 11 publications

Cystoid macular edema associated with iridocorneal endothelial syndrome: a case report

Cystoid macular edema associated with iridocorneal endothelial syndrome: a case report

A review of corneal melting following kerato‐refractive surgery

Phototherapeutic keratectomy

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