keratitis after prk extra
TRANSCRIPT
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By Dr. Amr Mounir
Lecturer of OphthalmologySohag University
Unusual keratitis after PRK EXTRA
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Financial disclosure • No financial interest
No financial interest
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Introduction:
- Suspicious cornea is a cornea with one or more risk factor for ectatic changes.
- The CXL procedure has demonstrated the revolutionary potential for retarding or eliminating the progression of Keratoconus and postoperative LASIK ectasia.
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- Several studies report the application of excimer laser ablation to correct astigmatism in patients with stable Keratoconus or suspicious cornea.- Combination of PRK and Corneal collagen crosslinking can be effective procedure in correction of mild errors in suspicious cornea.
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Case 1 A 25 years old female with bilateral error with suspect cornea
Rt. Eye : -3.50 Ds -1.00 Dc @149
Lt. Eye : -4.25 Ds -1.25 Dc @ 70
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Rt. Eye:
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Lt. eye:
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The decision was Transepithelial PRK with accelerated corneal collagen crosslinking in the same session in both eyes ( PRK Extra)
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First day ( Post)RT. Eye: Infiltrates at the depithelized ablated cornea extending outside the thickened whitish margin of area of ablation.No blepharospasm No Pain Lt. eye : Normal
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Corneal scraping was done and specimen was sent to Microbiology Lab.
Result : -ve
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What was that ???
Was it infection ???No pain No blepharospasm or photophobia White eye
Was it immune reaction ??
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Treatment
Treatment was broad spectrum topical antibiotic (Moxifloxacin) + topical steroids (Fluorometholone)
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END stage: After 2 months
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END stage
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Case 2 A 36 ys old female with bilateral error with suspect cornea
Rt. Eye : -1.00 Ds -3.75 Dc @ 5
Lt. Eye : -3.00 Ds -1.25 Dc @112
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Rt. Eye:
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Lt. Eye:
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The decision was Transepithelial PRK with accelerated corneal collagen crosslinking in the same session in both eyes ( PRK Extra)
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First day ( Post)Both eyes showed infiltrates at the depithelized ablated corneal center with thickened whitish masses at the margin of area of ablation.
- No blepharospasm - No Pain
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Corneal scraping was done and specimen was sent to Microbiology Lab.
Result : -ve
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Before starting treatment
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We should returned to literatures
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To diagnose that!!!
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Abdulrahman Al-Muammar Saudi J Ophthalmol. Saudi journal of ophthalmology 2011 Jul.
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Mohammad-Ali Javadi and Sepehr Feizi, Journal of Ophthalmic and Vision Research 2014 Oct-Dec
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Bhattacharya M et al, International journal of keratoconus and ectatic corneal diseases: Sep: Dec 2015
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Why sterile Keratitis ???- No Pain - No blepharospasm - Peripheral infiltrates- Immune ring - White eye - Sterile Keratitis had been reported after CXl and PRK- Negative Lab. results
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Sterile Keratitis ???
- Sterile keratitis is proposed to be an immune mediated response against staphylococcal antigen in tear pool behind bandage contact lens.
- Can occur after PRK or CXL.- Healed by opacifications if steroids
therapy not started rapidly.
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Treatment
We started topical prednisolone acetate and systemic steroids therapy with under cover of topical antibiotics therapy MoxifloxacinWith strict follow up for fear of imminent infection
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END Result:
Complete epithelial healing had occurred leaving central clear cornea with peripheral faint opacities in both eyes
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Lt.eye
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- Sterile keratitis is not uncommon complications after PRK and CXL.
- We should exclude infection liability by staining and cultures with clinical correlation .
- Early diagnosis means early aggressive steroids therapy with less scar formation liability.
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Thank you