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