Case Reports

Photorefractive keratectomy with mitomycin-C for the combined treatment of myopia and subepithelial infiltrates after epidemic keratoconjunctivitis

Case Report Details

First Author: O.Naves BRAZIL

Co Author(s):    M. Leoratti   F. Marujo   J. Okimoto   D. Diniz   F. Taguchi   R. Kobayashi     

Abstract Details

Purpose:

To report the use of photorefractive keratectomy (PRK) with mitomycin-C (MMC) to treat concomitant myopia and visually significant subepithelial infiltrates associated with epidemic keratoconjunctivitis (EKC).

Setting:

Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of Sao Paulo - UNIFESP, Brazil

Report of Case:

A 54-year-old woman developed visually debilitating subepithelial infiltrates in the left eye after EKC, 70 µm beneath the epithelium, measured with Optical Coherence Tomography Visante (Carl Zeiss Meditec, Inc.). She was legally blind in the right eye due to a secundary glaucoma, after pars plana vitrectomy for rhegmatogenous retinal detachment years ago. The infiltrates were treated with a 4-month course of tapering prednisolone acetate 1% followed by tacrolimus 0.03%, with partial success. Even after a year without topical steroids, the patient continued to complain of halos and glare. Her best corrected visual acuity (BCVA) was: hand motion in the right eye and 20/40 in the left eye, with a refraction: -5.25 -0.75 x 160º. Anterior biomicroscopy revealed 20 corneal infiltrates from center to periphery. After manual epithelial debridement, Wavefront-optimized PRK was perfomed using Alcon WaveLight® EX500 Excimer Laser, followed by MMC 0.02% for 1 minute. Target was emmetropia, with an ablation zone of 6.5mm and a central ablation depth of 87µm; Post operative medication included moxifloxacin 0.5% QID for 7 days; ketorolac 0.5% QID for 2 days; and prednisolone acetate 1.0% QID for 1 week, TID for 1 week, BID for 1 week and QD for 1 week. After 2 months, she had BCVA of 20/20̄¹ in the left eye with a refraction of +1.00 SD. She no longer reported glare or halo and the central cornea was clear, with no infiltrates.

Conclusion/Take Home Message:

The use of topical MMC in conjunction with PRK to treat subepithelial infiltrates due to EKC provided good visual and refractive results.

Financial Disclosure:

None