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      What is Central Toxic Keratopathy Syndrome if it is not Diffuse lamellar Keratitis Grade IV?

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          Abstract

          The Central Toxic Keratopathy (CTK) syndrome describes a rare, acute, self-limited, non-inflammatory process that yields central corneal opacification and significant hyperopic shift after refractive surgery. Despite being exceedingly rare, certain clinical features of CTK give the condition a striking resemblance to other more serious inflammatory conditions, including diffuse lamellar keratitis (DLK). As the authors demonstrate in this article, despite the overlapping clinical features, CTK is a disease process that is distinct from DLK and, therefore, in need of distinct management interventions.

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          Diffuse lamellar keratitis. A new syndrome in lamellar refractive surgery.

          Sean Maloney, J. Smith (1998)
          This study aimed to describe a syndrome that the authors call diffuse lamellar keratitis that follows laser in situ keratomileusis (LASIK) and related lamellar corneal surgery. Noncomparative case series and record review. Thirteen eyes of 12 patients in whom infiltrates developed in the interface after lamellar refractive surgery were studied. Topical antibiotics or corticosteroids or both were administered. Corneal infiltrate appearance, focality, location, and clinical course were measured. Patients presented between 2 and 6 days after surgery with pain, photophobia, redness, or tearing. Ten cases directly followed either myopic keratomileusis or LASIK. Three cases followed enhancement surgery without the use of a microkeratome. All 13 cases had infiltrates that were diffuse, multifocal, and confined to the flap interface with no posterior or anterior extension. The overlying epithelium was intact in each case. Cultures were negative in the two cases cultured. Ten eyes were treated with antibacterial agents; two eyes had fluorometholone four times daily added to the routine postoperative antibacterial regimen, and one eye had the antibacterial agent discontinued and was treated with topical fluorometholone alone. All infiltrates resolved without sequelae. A distinct syndrome of unknown cause of noninfectious diffuse infiltrates in the lamellar interface is described. It can be distinguished from infectious infiltrates by clinical presentation and close follow-up. Patients with the syndrome should be spared the more invasive treatment of infectious keratitis.
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            Methicillin-resistant Staphylococcus aureus infectious keratitis following refractive surgery.

            A R Rubinfeld, Majid Moshirfar, Keith R. Solomon … (2007)
            To elucidate risk factors, clinical course, visual outcomes, and treatment of culture-proven methicillin-resistant Staphylococcus aureus (MRSA) infectious keratitis following refractive surgery. Interventional case series. Multicenter chart review of 13 cases of MRSA keratitis following refractive surgery and literature review. Thirteen eyes of 12 patients, nine of whom were either healthcare workers or exposed to a hospital surgical setting, developed MRSA keratitis following refractive surgery. All patients presented with a decrease in visual acuity and complaints of pain or irritation in the affected eye. Common signs on slit-lamp biomicroscopy were corneal epithelial defects, focal infiltrates with surrounding edema, conjunctival injection, purulent discharge, and hypopyon. All patients were diagnosed with infectious keratitis on presentation and treated with two antibiotics. All eyes were culture-positive for MRSA. According to a computerized MEDLINE literature search, this is the first case series of MRSA infectious keratitis following refractive surgery, the first reports of MRSA keratitis after refractive surgery in patients with no known exposure to a healthcare facility, the first report of MRSA keratitis after a laser in situ keratomileusis (LASIK) enhancement, and the first reports of MRSA keratitis after prophylaxis with fourth-generation fluoroquinolones. MRSA keratitis is a serious and increasing complication following refractive surgery. Patients with exposure to a healthcare environment should be considered at additional risk for developing MRSA keratitis. However, in addition, surgeons should now be vigilant for community-acquired MRSA. Prompt identification with culturing and appropriate treatment of MRSA keratitis after refractive surgery is important to improve visual rehabilitation.
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              Central toxic keratopathy: description of a syndrome in laser refractive surgery.

              B Sonmez, Shane Maloney (2007)
              To describe the clinical spectrum of a syndrome in laser refractive surgery, which we call central toxic keratopathy, and to present cases that illustrate the range of this syndrome. Retrospective observational case series. Eyes with noninflammatory central corneal opacification in the immediate postoperative period after photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK) were identified, and the charts abstracted. Twenty-three eyes of 14 patients were identified who developed central corneal opacification three to nine days after laser refractive surgery. Nineteen of these eyes had LASIK and four had PRK. All eyes had central corneal opacification in the area of laser treatment that extended posteriorly from the interface into the stromal bed (in the case of LASIK eyes). The opacification persisted a minimum of two months to a maximum of 18 months before clearing. Nine eyes developed postoperative hyperopia of greater than 2 diopters. Pre- and postoperative best-spectacle corrected acuity was available on 19 eyes; one of these eyes lost two lines of corrected acuity, and two other eyes lost one line. Eighteen of 19 LASIK eyes had diffuse lamellar keratitis preceding the onset of corneal opacification. Central toxic keratopathy is characterized by noninflammatory central corneal opacification with a significant hyperopic shift. The opacification gradually clears over a period of months, leaving the eye hyperopic. Enhancement is indicated to treat residual hyperopia and remove residual striae. Topical or oral corticosteroid treatment is not indicated. The cause of central toxic keratopathy is unknown.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Middle East Afr J Ophthalmol
                Journal ID (publisher-id): MEAJO
                Title: Middle East African Journal of Ophthalmology
                Publisher: Medknow Publications (India )
                ISSN (Print): 0974-9233
                ISSN (Electronic): 0975-1599
                Publication date (Print): Jan-Mar 2010
                Volume: 17
                Issue: 1
                Pages: 60-62
                Affiliations
                Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
                [1 ]The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA
                [2 ]University of Utah School of Medicine, Salt Lake City, UT, USA
                Author notes
                Corresponding Author: Dr. Yousuf M. Khalifa, John A. Moran Eye Center, 50 North Medical Drive, Salt Lake City, UT 84132, USA. E-mail: yousuf.khalifa@ 123456hsc.utah.edu
                Article
                Publisher ID: MEAJO-17-21
                DOI: 10.4103/0974-9233.61218
                PMC ID: 2880375
                PubMed ID: 20543938
                SO-VID: 2cc866d9-e33c-4c6d-ae93-582d485da3e0
                Copyright © © Middle East African Journal of Ophthalmology
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Cornea/Refractive Update

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: prk,laser in situ keratomileusis,diffuse lamellar keratitis,keratitis,central toxic keratopathy
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: prk, laser in situ keratomileusis, diffuse lamellar keratitis, keratitis, central toxic keratopathy

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