Case Study- 7 months post operative LASIK procedure – Tips4EyeDocs

This 60year old woman is status post LASIK, OU,  7 months. Everything went well until this.

She presents with mild light sensitivity, but not photophobic. The fellow eye is as red with and looks like this.CF 7ft is the vision PHNI. Pupils are reactive. No cells/flare in the AC. Cornea folds (~15% to 20% CCT increase) and obivous demarcation of the flap border where none was evident. Afebrile, normal pulse, normal oxygenation,. Cutlure negative(!)  (97F)

What would you do?

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About Richard Hom OD, MPA

Dr. Hom holds Doctor of Optometry and Masters in Public Administration degrees and practices family eye care and consults on public policy, health information technology and program evaluation.
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24 Responses to Case Study- 7 months post operative LASIK procedure – Tips4EyeDocs

  1. Michael Tsatsos says:

    This patient needs full investigations. By culture do you mean corneal scrapes?
    Any medical history i.e Rheumatoid arthritis?

    Needs flap lift and scrape at the base of the stroma and possibly washout with antibiotics but at least this would lead to a higher yield of microorganisms.
    Then, the photo is not great but I can see some corneal thinning so inflammatory markers need to be checked.



  2. Frank Won says:

    I haven’t looked at the patient, but I might prescribe an antibiotic for coverage, Pred Forte 1% QID and Muro 128 TID. Get their corneal surgeon involved if accessible, if not, follow up with your cornea guy. This might be a kind of inflammatory Ectasia. She needs to see her surgeon stat. It unfortunately looks like the flap interface could split back open with enough edema, that’s a rough case. How high was her Rx pre-Tx? Was she a high myope? This might be post-operative ectasia or endothelial thinning.

  3. Brad Sanger says:

    What about neurotrophic? also is there a history of HSV?

  4. Frank Won says:

    HCV related Sjogren’s Syndrome?

  5. Brad Sanger says:

    I was just going to ask for clues from review of systems…

  6. Brad Sanger says:

    why the interferon?

  7. Brad Sanger says:

    oh I get your comment to Frank now, hepatitis related keratitis.

  8. Brad Sanger says:

    That is very interesting. Thank you very much for sharing.

  9. rightingtruth says:

    omg cliffhanger.

  10. Frank Won says:

    ^^ that was supposed to be me.

  11. Deegan Lew says:

    Hi Richard,
    Which interferon therapy? Was it Pegasys (Peg interferon A 2 alpha)? There have been documented problems with Pegasys with Ribavirin.

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