Acute Neurotrophic Postlasik Keratopathy – A Case Report.

PostLASIK neurotrophic keratopathy is a degenerative affection of the cornea caused by impairment of corneal sensitivity due to surgery and the toxicity of topical anesthetics. Corneal epithelial changes (epithelial keratopathy, opacification, ulceration) can occur acutely on the 2nd day after the LASIK procedure and represents therapeutic challenge.

The present case report concentrates on the etiology, pathogenesis, diagnosis and therapeutic aspects for treating postLASIK neurotrophic keratopathy.

A 32-year-old patient underwent uncomplicated LASIK surgery for low myopia. On the second postoperative day, the left interface was irrigated with antibiotics for central opaque map-like density with a vision of 0.4. Below the center of the right eye, only a dot epithelial change was found with a vision of 0.9. We treated the subsequent development of neurotrophic keratopathy with therapeutic contact lenses, autologous serum and antibiotics. Corneal finding was monitored with OCT, epithelial map included.

Stabilization of natural vision ( right 1.0 and left 1.25), healing of the epithelium and reduction of the previously experienced symptoms like burning were achieved within 5 weeks.

Severe denervation after bilateral LASIK and toxic effect of huge amount of anesthetics preoperatively disrupts ocular tear film dynamics and causes epithelial affections even shortly after LASIK. Immediate treatment prevents the development of further complications after an otherwise uncomplicated refractive procedure.