A Corneal Ring Infiltrate Following Micropulse Cyclophotocoagulation

To report a case of neurotrophic keratopathy following micropulse cyclophotocoagulation (MP-CPC), presenting as a ring infiltrate with diagnostic challenges.

Cornea clinic at a tertiery eye care hospital

A 36-year-old diabetic female was referred to cornea clinic for a new onset of a ring infiltrate in her right eye, one month after undergoing (MP-CPC) procedure for an uncontrolled neovascular glaucoma. Few days prior to glaucoma procedure, she received a panretinal photocoagulation (PRP) and Intravitreal bevacizumab injection on her right eye for a proliferative diabetic retinopathy. On presentation, she was not complaining of pain or discharge, yet, bothered by photophobia. After obtaining a proper medical history, best corrected visual acuity was 3/200 in the affected eye, corneal sensitivity was reduced and slit lamp examination showed a large inferior corneal epithelial defect with a peripheral anterior stromal ring infiltrate. Corneal scrapings were obtained and a list of differential diagnosis were excluded, until a proper diagnosis of a sterile ring infiltrate secondary to neurotrophic keratopathy was reached.

Neurotrophic keratopathy presenting as a corneal ring infiltrate, can be confused with infectious keratitis and result in diagnostic challenges. As cases of NK after MP-CPC are more frequently reported, a routine preoperative assessment of corneal sensation especially in patients at risk, such as diabetics is recommended. Pre-operative counselling, customized treatment protocols such as shortening the treatment time, as well as a closer post-operative observation should be considered.