PRK and Epidemic Keratoconjunctivitis
As photorefractive keratectomy became a popular refractive surgery procedure, Talamo theorized that the destruction of Bowman’s layer during uneventful photorefractive keratectomy (PRK) causes abnormal healing, subepithelial infiltrates, and associated sc
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Jaime Javaloy, Dominika Wróbel, and Alessandro Abbouda
Contents Why Is This Case Relevant for the Refractive Surgeon? ..................................
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Case Background ...................................................
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Main Problem to Solve ..........................................
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Ancillary Tests ........................................................
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Surgical/Medical Intervention ..............................
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Outcome ..................................................................
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What to Learn from This Case .............................
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References ...............................................................
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J. Javaloy, MD, PhD (*) Department of Anterior Segment and Refractive Surgery, Vissum Corporacion Oftalmológica, Alicante, Spain e-mail: [email protected] D. Wróbel, MD Glaucoma Diagnostic and Microsurgery Department, Medical University of Lublin, Lublin, Poland R&D Department, Vissum Corporacion, Alicante, Spain e-mail: [email protected] A. Abbouda, MD Department of Refractive Surgery, Vissum Corporación Oftalmológica, Alicante, Spain Department of Ophthalmology-Policlinico Umberto I of Rome, University of Rome “Sapienza”, Viale del Policlinico, 155, 00186 Roma, Italy R&D Department, Vissum Corporación Oftalmológica, 03016 Alicante, Spain e-mail: [email protected]
Why Is This Case Relevant for the Refractive Surgeon? As photorefractive keratectomy became a popular refractive surgery procedure, Talamo theorized that the destruction of Bowman’s layer during uneventful photorefractive keratectomy (PRK) causes abnormal healing, subepithelial infiltrates, and associated scarring [1]. Recurrent adenoviral stromal keratitis is thought to express a delayed hypersensitivity immune response to viral antigens in the corneal stroma [2]. Refractive surgeons should be aware that damages in Bowman’s layer and hyperactiveness of keratocytes induced by PRK may cause an abnormal healing response in a patient who suffers from epidemic keratoconjunctivitis (EKC) [3].
Case Background A 33-year-old woman underwent bilateral uneventful PRK for moderate myopia of −5.50 −0.50 20° in the right eye and −5.75 −0.50 20° in the left eye. The best corrected visual acuity (BCVA) was 20/20 in both eyes. Preoperative corneal pachymetry was 515 μm in both eyes. Keratometry readings before surgery were 44.21 /45.12 × 24 º in the right eye and 44.35 /45.13 × 10° in the left eye. According to the topography, her corneal surface was regular. The slit lamp and fundus examinations were normal. She had worn soft contact lenses for many
J.L. Alió et al. (eds.), Difficult and Complicated Cases in Refractive Surgery, DOI 10.1007/978-3-642-55238-0_65, © Springer-Verlag Berlin Heidelberg 2015
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years. Before surgery, our patient had not had a clinical history of adenoviral keratoconjunctivitis in either eye. Uneventful transepithelial photorefractive keratectomy was performed in both eyes. MMC 2 % was applied for 30 sec. The total calculated ablation dept
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