delayed corneal perforation secondary to topical diclofenac use after lasek

purpose: to report a case of delayed corneal perforation secondary to topical diclofenac usage after myopic lasek and review of literature. patients and findings: a 25-year-old female with history of myopic lasek 2 months before referred to her surgeon with epithelial defect, stromal thinning and infiltration. she was treated with antimicrobial medications for infectious keratitis for one week. she was then referred to labbafinejad medical center because of lack of response and progressive stromal thinning. two days after admission, corneal perforation was occurred. smear and culture of the cornea were negative. she had used topical diclofenac for 6 weeks. after discontinuing the topical medications and conservative measures (oral acetazolamide, patching, simple eye ointment) the perforation started healing. conclusions:  prolonged use of topical non-steroidal anti-inflammatory drugs after surface ablation may lead to stromal melting and corneal perforation; therefore, such medications should be used cautiously in these patients especially in high risk groups such as rheumatoid arthritis, dry eye syndrome, ocular surface disorders and neurotrophic keratopathy.