Central Toxic Keratopathy after Surface Laser Refractive Surgery: a Case Series and Brief Review

Purpose: To describe clinical presentation, management, and outcomes of central toxic keratopathy developing after surface laser refractive surgeries. Patients and Methods: In this retrospective case series, the records of 10 eyes of 5 patients (1 male, 4 female) were reviewed. The laser refractive surgery consisted of photorefractive surgery (PRK; 2eyes) and laser-assisted subepithelial keratectomy (LASEK; 8 eyes). Mitomycin C, 0.02 % was applied intraoperatively in all eyes. Results: The mean patient age was 30 ± 14.5 years, (22 to 56 years). Presenting symptom was decreased vision without pain or photophobia in all cases that began 3 to 9 days postoperatively. The slit-lamp examination revealed corneal opacities and corneal thinning in the central area of the cornea corresponding to the ablated zone. There were no corneal epithelial defects or corneal stromal infiltration. Upon presentation, the mean best-corrected distance visual acuity was 20/25 (LogMAR 0.83 ± 0.34). The opacification persisted for a minimum of two months to a maximum of 6 months before clearing. The patients were followed up for 12 months. Five eyes had a decrease of 1 to 2 lines in preoperative best-corrected distance visual acuity 6 months postoperatively. All eyes had hyperopic shift and astigmatism during the follow-up period. The mean spherical equivalent at final follow up was + 0.75 ± 1.15 diopter. Conclusion: Central toxic keratopathy is a non-inflammatory central corneal opacification which is associated with significant hyperopic shift and stromal tissue loss. Visual prognosis is usually good but a decrease in best-corrected distance visual acuity may persist in some cases.