Date post: | 12-Apr-2017 |
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By Dr. Amr Mounir
Lecturer of OphthalmologySohag University
Unusual keratitis after PRK EXTRA
Financial disclosure • No financial interest
No financial interest
Introduction:
- Suspicious cornea is a cornea with one or more risk factor for ectatic changes.
- The CXL procedure has demonstrated the revolutionary potential for retarding or eliminating the progression of Keratoconus and postoperative LASIK ectasia.
- Several studies report the application of excimer laser ablation to correct astigmatism in patients with stable Keratoconus or suspicious cornea.- Combination of PRK and Corneal collagen crosslinking can be effective procedure in correction of mild errors in suspicious cornea.
Case 1 A 25 years old female with bilateral error with suspect cornea
Rt. Eye : -3.50 Ds -1.00 Dc @149
Lt. Eye : -4.25 Ds -1.25 Dc @ 70
Rt. Eye:
Lt. eye:
The decision was Transepithelial PRK with accelerated corneal collagen crosslinking in the same session in both eyes ( PRK Extra)
First day ( Post)RT. Eye: Infiltrates at the depithelized ablated cornea extending outside the thickened whitish margin of area of ablation.No blepharospasm No Pain Lt. eye : Normal
Corneal scraping was done and specimen was sent to Microbiology Lab.
Result : -ve
What was that ???
Was it infection ???No pain No blepharospasm or photophobia White eye
Was it immune reaction ??
Treatment
Treatment was broad spectrum topical antibiotic (Moxifloxacin) + topical steroids (Fluorometholone)
END stage: After 2 months
END stage
Case 2 A 36 ys old female with bilateral error with suspect cornea
Rt. Eye : -1.00 Ds -3.75 Dc @ 5
Lt. Eye : -3.00 Ds -1.25 Dc @112
Rt. Eye:
Lt. Eye:
The decision was Transepithelial PRK with accelerated corneal collagen crosslinking in the same session in both eyes ( PRK Extra)
First day ( Post)Both eyes showed infiltrates at the depithelized ablated corneal center with thickened whitish masses at the margin of area of ablation.
- No blepharospasm - No Pain
Corneal scraping was done and specimen was sent to Microbiology Lab.
Result : -ve
Before starting treatment
We should returned to literatures
To diagnose that!!!
Abdulrahman Al-Muammar Saudi J Ophthalmol. Saudi journal of ophthalmology 2011 Jul.
Mohammad-Ali Javadi and Sepehr Feizi, Journal of Ophthalmic and Vision Research 2014 Oct-Dec
Bhattacharya M et al, International journal of keratoconus and ectatic corneal diseases: Sep: Dec 2015
Why sterile Keratitis ???- No Pain - No blepharospasm - Peripheral infiltrates- Immune ring - White eye - Sterile Keratitis had been reported after CXl and PRK- Negative Lab. results
Sterile Keratitis ???
- Sterile keratitis is proposed to be an immune mediated response against staphylococcal antigen in tear pool behind bandage contact lens.
- Can occur after PRK or CXL.- Healed by opacifications if steroids
therapy not started rapidly.
Treatment
We started topical prednisolone acetate and systemic steroids therapy with under cover of topical antibiotics therapy MoxifloxacinWith strict follow up for fear of imminent infection
END Result:
Complete epithelial healing had occurred leaving central clear cornea with peripheral faint opacities in both eyes
Lt.eye
- Sterile keratitis is not uncommon complications after PRK and CXL.
- We should exclude infection liability by staining and cultures with clinical correlation .
- Early diagnosis means early aggressive steroids therapy with less scar formation liability.
Thank you