Surgically induced corneal necrotizing keratitis following LASIK in a patient with inflammatory bowel disease

Abstract

We describe a case of necrotizing keratitis that developed after laser in situ keratomileusis (LASIK) in a 50-year-old woman with inflammatory bowel disease. The patient had not disclosed her history of a total colectomy for recurrent ulcerative colitis and developed bilateral stromal inflammation and corneal melting along the flap edge with ulceration within 3 days of uneventful bilateral LASIK for myopia. She was aggressively managed with topical and systemic corticosteroid therapy. Flap infiltrates gradually resolved, with no relapse during the 12-month follow-up. This case highlights the importance of taking a detailed history, specifically addressing autoimmune diseases, before corneal refractive surgery.

Effect of the combination of basic fibroblast growth factor and cysteine on corneal epithelial healing after photorefractive keratectomy in patients affected by myopia

“…The degree and extent of keratocyte apoptosis also varies with the type of overlying epithelial injury, and can be influenced by the surgical technique and drugs. [121314151617181920212223242526272829303132333435363738394041424344454647] Therefore, rapid re-epithelialization of the cornea would likely promote wound healing of the underlying stroma with minimal cell apoptosis. [38] Furthermore, the identification of factors that aid re-epithelialization after corneal epithelial injury and prevent complications related to delayed cicatrization, such as scar or haze formation, would optimize surgical outcomes.…”

Idiopathic peripheral necrotizing keratitis after femtosecond laser in situ keratomileusis

“…However, sterile peripheral infiltrates after LASIK have been reported, 1-8 including 1 case of necrotizing peripheral infiltrates after LASIK in a patient with inflammatory bowel disease. 8 These cases have been reported with the use of a microkeratome and a femtosecond laser (Intralase, Abbott Medical Optics, Inc.).…”

Successful Diagnosis and Treatment of a Single Case of Bilateral Necrotizing Keratitis following Femtosecond-LASIK

“…Lahners et al 8 reported on a patient with known rheumatoid arthritis, who developed bilateral infiltrates after LASIK to the right eye only, demonstrating that surgery in just one eye can trigger an immune reaction in both eyes. Carp et al 10 described a case of necrotizing keratitis that developed after LASIK in a patient with inflammatory bowel disease. The potential initiating events for an immunologic reaction include the deposition of immune complexes, serum autoantibodies, vasculitic injury, aberrant expression of HLA-II antigens on corneal epithelium and keratocytes, or an aberrant cellmediated response to corneal injury.…”