Topographic And Pachymetric Follow-Up Treating Haze After Photorefractive Keratectomy

To present one case of haze after photorefractive keratectomy (PRK) inducing irregular astigmatism, treated with steroid eye drops and its topographic and pachymetric changes.

Instituto Oftalmologico Hoyos. Sabadell-Barcelona (Spain)

61-year-old male patient with rheumatoid arthritis was operated on with PRK in 2019 to correct -2.75 D. He referred to a decrease in vision in the left eye after the summer of 2021, which got worse after the following summer. He arrived at our clinic in October 2022 with an inferior corneal opacity in the left eye, uncorrected visual acuity (UCVA) of 20/50 and best corrected visual acuity (BCVA) of 20/30 with a refraction of +1 -2 x 100º.  Pentacam topography showed an irregular astigmatism with an inferior steepening of 53 D, similar to a keratoconus. The posterior elevation was normal, and the steepest point coincided with the thickest point of the cornea (more than 600 microns). We prescribed prednisone and tear drops five times a day.

The haze began to decrease after the first month and we began to decrease steroid doses. Now, five months later he is using one drop of prednisone a day and BCVA is 20/20 with a refraction of +0.50 -1.75 x 95º. In the previous pseudokeratoconic area, Pentacam topography shows a regular astigmatism with a flattening of 9.8 D and a decrease of 60 microns in corneal thickness.

This case of inferior corneal haze which induced corneal thickening and steepening like-keratoconus, improved with steroid treatment. Ultraviolet rays during summer and rheumatoid arthritis could be related with this strong haze after PRK.