Active Early Management Of Central Toxic Keratopathy: A 20-Eye Imaging-Confirmed Case Series Demonstrating Accelerated Recovery

Central toxic keratopathy (CTK) is traditionally described as a non-inflammatory, self-limited complication resolving over several months without effective pharmacologic treatment. We evaluated whether early multimodal therapy could actively modify the clinical course of imaging-confirmed CTK.

Eye Clinic Svjetlost, Zagreb, Croatia

Retrospective interventional case series of 20 consecutive eyes developing CTK following PRK, LASIK, or keratorefractive lenticule extraction (KLEx). Diagnosis was established at a median of postoperative day 3 and required central nummular stromal opacity, ≥1.00 D hyperopic shift, ≥3.00 D central keratometric flattening, stromal thinning, and funnel-shaped stromal hyperreflectivity on anterior segment OCT. DLK, infection, and interface fluid syndrome were excluded clinically and by imaging. Upon diagnosis, corticosteroids were immediately discontinued and patients were treated with topical cyclosporine A, olopatadine, and timolol. Primary endpoint was time to ≥75% reversal of peak hyperopic shift.

Maximum hyperopic shift reached +7.00 D, with ≥3.00 D central flattening in all cases. Improvement began within 2 weeks in every eye. Median time to ≥75% refractive reversal was 6 weeks—substantially shorter than historically described recovery timelines. No case progressed after treatment initiation. Structural normalization on OCT paralleled refractive recovery. No residual hyperopia remained at final follow-up. One bilateral case occurred following KLEx.

Early targeted pharmacologic intervention was associated with consistent and accelerated recovery in CTK. These findings challenge the traditional view of CTK as purely self-limited and suggest the presence of an early modifiable stromal phase. Prospective controlled studies are warranted to determine whether active management should replace observation as standard care.