Case Reports

Presbyopia-inlay extrusion through late corneal melt: surgical revision and long term management of a potentially vision threatening complication

Case Report Details

First Author: F.Xhani GREECE

Co Author(s):    A. Kanellopoulos                    

Abstract Details

Purpose:

To report a late, serious complication of corneal stromal melt and inlay extrusion 6 years following initial implantation, along with the surgical revision and management for visual rehabilitation over 3 years.

Setting:

LaserVision.gr Clinical and Research Eye Institute

Report of Case:

A 45 yo female underwent uneventful topography-guided, femtosecond laser-assisted hyperopic LASIK, combined with same day polymer refractive inlay implantation in the non-dominant eye for presbyopia treatment. The early post-operative visual acuity and refractive data, subsequent removal 6 years later, due to late anterior stromal melt and extrusion, medical management and visual rehabilitation over 36 months, with extensive anterior segment imaging is reported. Initial pre-op UDVA was 20/50, and CDVA 20/20 with a +3.50 OU. Both eyes were treated with a +3.50 ablation and a 150 micron femto-LASIK flap. Respective Post-op UDVA: 20/20+, and 20/25 in the OS, CDVA 20/20 with 0.50 Diopters myopic refraction. Respective UNVA was J5 in the OD and J1+ in the OS, J1 OU. Past the treatment with topical antibiotics for a week and corticosteroids for up to 2 months, the patient had uneventful subsequent course and was lost to follow-up after 3 years. She presented at year 6 with sudden reduction of vision in the inlay eye and an “empiric” diagnosis from another clinician of “fungal keratitis”. UDVA and UNVA in the OS were 20/100 and J8 respectively. Clinical exam and anterior segment OCT imaging confirmed anterior corneal melt and inlay extrusion through the initial LASIK flap. The inlay was explanted through the original LASIK flap button-hole perforation. Long term management with oral antiproteolysis, topical steroids and cyclosporine-A solution over several years resulted conservatively, 36 months later in UDVA 20/25 and UNVA J5

Conclusion/Take Home Message:

Intra-corneal refractive synthetic-inlays, maybe associated with severe potential complications even following multiple years and falsely-perceived quiescence following implantation. Clinical assessment, medical and surgical management, along with caution for late signs of corneal melt, are reported.

Financial Disclosure:

None