Severe Bilateral Paralimbal Sterile Infiltrates after Photorefractive Keratectomy
A 47-year-old male patient underwent bilateral PRK for myopic astigmatism. The patient was in good health, did not take any systemic medications and the ocular history was unremarkable. The pre-operative manifest refractions were −1.25 −1.00 × 110 right eye and −1.75 −0.50 × 70 left eye.\nBilateral PRK was performed on the same day. Two drops of topical anesthetic were instilled in the eye undergoing surgery. The eyes were draped with a plastic sheet. A lid speculum was inserted for maximum globe exposure. The corneal epithelium was removed by mechanical debridgement using a sponge soaked in topical oxybuprocaine hydrochloride 0.4% (benoxinate) and a surgical blade. The surgical procedure was uneventful and a bandage contact lens was placed at the end of surgery. The patient was discharged with instructions to instill topical ofloxacin 4 times a day and diclofenac sodium (Voltaren; Novartis AG, Basel, Switzerland) 6 times a day for pain. No topical steroids were prescribed.\nOne day post-operatively, the visual acuity was 20/25. Slit lamp examination revealed bilateral corneal infiltrates outside the treatment zone with intact epithelium and clean central epithelial defects and quiet anterior chambers [].\nThe contact lenses were removed and corneal scrapings were sent for microbial studies. The patient was placed on topical steroid 4 times a day and topical ofloxacin hourly and the voltaren was stopped.\nMicrobiology studies were negative for any microorganisms. Two days post-operatively, the corneal infiltrates were less prominent than at original presentation. By the sixth post-operative day, the epithelium had completely healed bilaterally. The patient improved on topical steroid and antibiotics within 2 weeks. The central corneas remained clear throughout follow-up. Steroids were tapered over a month and the infiltrates resolved with faint peripheral corneal scarring and final CDVA of 20/25 [].