Clinical Case Report: Laser Vision Correction In A Patient With Thygeson’S Keratitis

Despite the high level of advancement in modern laser refractive surgery, questions regarding the feasibility of laser vision correction sometimes remain unresolved. Universally recognized contraindications include inflammatory and autoimmune diseases of the cornea, among which is Thygeson's keratitis. The aim of this report is to present a clinical case of a such a patient who underwent laser vision correction using the TransPRK method.

"Sphere" Eye Clinic, Moscow, Russia. Outpatient treatment and subsequent surgical intervention.

A 36-year-old patient with stable low myopia since childhood requested laser vision correction due to contact lens (CL) intolerance. Initial examination: UCVA each eye = 0,1 OU, BCVA each eye = 1,0. Autorefractometry: OD −sph 2,25 D cyl −0,5 D ax 150°, OS −sph 2,5 D. Schirmer test 13 mm OU, tear break-up time: OD 18 sec, OS 13 sec. Biomicroscopy noted isolated superficial intraepithelial opacities outside and within optical zone OU. Fluorescein test was negative. Other structures were unchanged. We suggested contact lens intolerance and prescribed lubricant eye drops 4-6 time a day and CL removal.

At follow-up visit lesion count increased, prompting suspicion of Thygeson's keratitis. Topical steroid and antibacterial therapy initiated. After 4 days, clinical improvement with nodule resolution and restored corneal transparency. Treatment discontinued after 3 weeks.

Two weeks later, patient came with recurrence of multiple intraepithelial grayish nodules. Serology revealed elevated IgG titers to CMV. Confocal microscopy confirmed signs of Thygeson's keratitis. After 5 months of topical steroid therapy (dexamethasone tapering), stable remission achieved.

In remission period (clear cornea, steroid treatment discontinued for 2 months), patient underwent transepithelial PRK with standard postop medication. At 5.5 months post-surgery: UCVA each eye =1.0; objective refraction OD Sph +0,25 D cyl -0,5 D ax 178, OS Sph +0,25 D cyl -0,25 D ax 164 was stable; corneas clear.

This observation illustrates the possibility of performing laser vision correction using the TransPRK approch in patients with Thygeson's keratitis after achieving stable remission. Superficial Thygeson's keratitis requires thorough diagnostic, long-term anti-inflammatory treatment with local steroids as a preparation for refractive surgery and dynamic follow-up.