Hypersensitivity reactions after femtosecond laser small incision lenticule extraction: a case report of corneal infiltr
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Allergy, Asthma & Clinical Immunology Open Access
CASE REPORT
Hypersensitivity reactions after femtosecond laser small incision lenticule extraction: a case report of corneal infiltrates Jiaonan Ma1†, Lin Zhang1,2†, Mengdi Li1 and Yan Wang1,2*
Abstract Background: Femtosecond laser corneal refractive surgery is generally considered safe and effective; however, this procedure is rarely associated with severe allergic reactions. We reported a rare case of hypersensitivity reactions which caused bilateral peripheral corneal infiltrates after femtosecond laser small incision lenticule (SMILE) surgery in a man with a history of fruits allergy. Case presentation: Here we report the case of a young man who developed white, ring-shaped bilateral peripheral infiltrates that appeared 1 day after an uneventful SMILE surgery. The overlying corneal epithelium was intact; the infiltrate was negative for bacterial culture, but high titers of immunoglobulin E was demonstrated in the blood. Symptomatically, a clinical diagnosis of sterile corneal infiltrates was made, and the patient was treated with topical and systemic steroids. The infiltrates were immunogenic in origin, which may be caused by the contact lenses used for suction duration in surgery. It resolved without corneal scarring in the subsequent months following steroid treatment. The patient’s visual acuity improved. Conclusions: When patients with a history of allergy who aim to perform corneal refractive surgery, surgeons must consider possible hypersensitivity reactions after treatment. More studies are needed to clarify the relationship between contact glass used in femtosecond laser corneal refractive surgery and IgE mediated hypersensitivity reactions. Keywords: Cornea, Refractive surgery, Contact glass, Hypersensitivity reaction Background Femtosecond laser small incision lenticule extraction (SMILE), which involves intrastromal lenticule cutting and subsequent lenticule extraction, has emerged as a preferred refractive surgery for myopia correction. As with all ophthalmic procedures, SMILE is associated with certain complications [1, 2]. Infective keratitis is potentially the most sight-threatening complication *Correspondence: [email protected] † Jiaonan Ma and Lin Zhang are co-first authors of the manuscript 1 Clinical College of Ophthalmology, Tianjin Medical University, No 4. Gansu Road, He‑ping District, Tianjin 300020, China Full list of author information is available at the end of the article
experienced after SMILE [3]. However, there is no report of peripheral sterile keratitis after SMILE. Incidence of sterile corneal infiltrate has been reported after photorefractive keratectomy (PRK), laser-assisted in situ keratomileusis (LASIK), and corneal crosslinking (CXL) [4–13]. This complication is usually benign, but its diagnosis warrants careful observation. It is easily misdiagnosed as infective keratitis, which is managed differently. Herein, we report a case of bilateral peripheral sterile infiltrate caused by a local immune response th
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