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Controversies in the diagnosis and management of central toxic keratopathy (CTK)

Poster Details

First Author: M.Samuel UK

Co Author(s):                        

Abstract Details

Purpose:

Central Toxic Keratopathy still remains a less understood condition making the diagnosis and management difficult. It has been described as a non inflammatory interface complication after LASIK which despite similarities to grade 4 DLK has been described as a separate entity. It has also been described that the condition is self-limiting and does not respond topical steroids or surgical intervention. The purpose of our study is to prove that the condition is not a separate entity but an early onset Grade 4 DLK and that it responds to surgical intervention with a flap lift combined with intensive topical steroids

Setting:

OPTIMAX LASER EYE CLINICS, UNITED KINGDOM

Methods:

It was a retrospective study. Notes were reviewed.Three cases had bilateral Femtosecond LASIK. One case presented with DLK in the left eye on first day which progressed to G4 DLK in 3 days. The patient was treated with topical steroids and improved gradually over next 4 months.The other two cases developed bilateral DLK on first day. This progressed very rapidly to grade 4 on the second day with corneal haze and stria. The case was treated with flap wash out and intensive steroids with quick improvement of symptoms in 3 days and improvement in visual recovery within 3 months.

Results:

It was a retrospective study based on review of surgical notes of three patients who presented with DLK which rapidly progressed to Grade 4 DLK and a tentative diagnosis of CTK was made. One case was treated with intensive topical steroids and improved gradually over next 4 months. Two cases were treated surgically by flap lift a and interface washout and these two cases showed rapid improvement in symptoms in 2 to 5 days and complete visual rehabilitation in 3 to 4 months of the surgical intervention

Conclusions:

We propose CTK is not a separate entity but a variant of Grade 4 DLK or early onset Grade 4 DLK when the inflammation progresses from Grade 1 to Grade 4 DLK in a matter of couple of days. We propose surgical intervention with flap washout accompanies by intensive steroids results in quick improvement of symptoms and complete visual recovery in a matter of weeks

Financial Disclosure:

NONE

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