Presbyopic Corneal Inlay Extrusion Consequent To Sterile Keratolysis: Surgical Revision And Long Term Management.

Intra-corneal refractive inlays have been used for the correction of presbyopia. Among reported complications with their clinical use are: infection, abnormal wound healing leading to corneal haze, dislocation, decentration, keratolysis, that may necessitate explantation. In this report, we describe a serious vision-threatening complication following the implantation of a presbyopic inlay, in combination with hyperopic LASIK.

the Laservision Clinical and Research Institute, Athens, Greece

A 55 year-old hyperopic male underwent uneventful topography-guided, bilateral femtosecond laser-assisted hyperopic LASIK, combined with same day polymer refractive-inlay implantation in the non-dominant eye for additional presbyopia correction. Within 2 months, anterior sterile keratolysis and partial extrusion required surgical explantation of the inlay and long-term medical management over 9 years achieved effective visual rehabilitation documented also with corneal imaging. Immediate postoperative results were binocular 20/20- UDVA (Uncorrected Distance Visual Acuity) and J1 UNVA (Uncorrected Near Visual Acuity). The early progressive anterior sterile keratolysis and partial extrusion necessitated surgical explantation at 2 months, severe anterior scarring of the perforated flap area and severe focal flattening of the cornea of over 10 diopters, developed despite aggressive topical corticosteroid use. UDVA in the OS dropped from 20/25 to 20/400. The LASIK flap portion that underwent keratolysis and perforated, remodeled long-term: from a scarred, epithelial plug with early significant surface concavity, to evidently a mild subepithelial localized hazy area with regularized curvature, over a period of 9 years.

Some refractive synthetic corneal inlays have been recalled as they may result in significant corneal haze; we present herein a case of severe keratolysis that necessitated surgical explantation and further document long-term care for eventual visual rehabilitation.