CTK in an Uncomplicated Femto-LASIK from Possible Occupational Exposure

Abstract

Introduction: A 22-year-old myopic male presented for LASIK. The patient’s work environment, in the pet cremation services industry, is prone to jobrelated dust and other particles. After an incident-free LASIK, grade 1 Diffuse Lamellar Keratitis (DLK) was found in the patient’s left eye the next day, along with a UCVA of 20/50; the right eye showed signs of inferior punctate keratopathy but was otherwise normal. By day 3, the DLK had progressed to grade 4, also described as Central Toxic Keratopathy (CTK), with mud-crack striae visible despite aggressive hourly topical steroids.

Methods: Case report, incidence report, and literature review.

Results: The patient developed Central Toxic Keratopathy (CTK) in the left eye with a noted hyperopic shift in refraction and mud crack appearance after LASIK on postoperative day 3. Treatment involved hourly topical Difluprenate .05% and Gatifloxacin 0.3%; in addition, a dexamethasone ophthalmic insert (Dextenza®, Ocular Therapeutix, Bedford, MA) was placed in the left eye, with complete resolution occurring within two weeks.

Conclusion: This case demonstrates the use of a dexamethasone ophthalmic insert (Dextenza®, Ocular Therapeutix, Bedford, MA) as a potential treatment of rapidly progressing DLK.