Unilateral Peripheral Sterile Infiltrates after Myopic Laser Epithelial Keratomileusis: Relationship with Postoperative Pain

Dear Editor, Peripheral corneal infiltrates are associated with several causes, including infectious keratitis, staphylococcal marginal keratitis, and peripheral keratitis related with autoimmune disease or contact lenses [1,2]. Peripheral corneal infiltrates after corneal refractive surgery are rare, and most of them are bilateral [1,2]. We report a case of unilateral peripheral infiltrates that was probably caused by localized immune reaction related with severe postoperative pain after uneventful laser epithelial keratomileusis (LASEK) in both eyes. A 26-year-old man was referred for ocular pain in his right eye. He had undergone epithelial f lap-off LASEK with mitomycin C in both eyes 4 days prior. The therapeutic contact lens (unknown material) in the right eye had been lost on his way home after the surgery. He had presented with severe ocular pain in the right eye on the following day, and an operating doctor had prescribed topical moxif loxacin 0.5% on suspicion of infectious keratitis; however, his ocular pain was not resolved. We were told that there was no difference in surgical technique between his two eyes. On examination in Seoul National University Hospital, his uncorrected visual acuity was counting finger in the right eye and 20 / 30 in the left eye. Intraocular pressure was within normal limits. Slit lamp examination revealed diffuse conjunctival injection, a central 6 × 5-mmsized epithelial defect, and whitish peripheral circumferential band-shaped corneal infiltrates extending from 3 to 9 o’clock in the right eye (Fig. 1A and 1B). The infiltrates were separated from the limbus by a distinct lucid interval. There was no cellular reaction in an anterior chamber, and the epithelium overlying the infiltrate was intact. The left cornea was clear, and epithelial healing was nearly complete. No meibomian gland dysfunction or blepharitis was observed in either eye. Corneal scraping was performed to confirm an infectious cause, and fortified antibiotics (vancomycin 2.5% and amikacin 2.0%) were administered hourly. A therapeutic contact lens (Acuvue Oasys; Johnson & Johnson, Madison, FL, USA) with a base curve radius of 8.80 mm was inserted in his right eye. The infiltrate was persistent although the central epithelial defect was completely closed 4 days after instillation of the fortified antibiotics. A localized immune reaction was suspected, and the patient was treated with topical prednisolone 1.0% combined with moxif loxacin 0.5%, six times a day. Systemic prednisolone was administered once a day with releKorean J Ophthalmol 2017;31(1):86-87 ht tps://doi.org/10.3341/k jo.2017.31.1.86