Acute corneal necrosis after excimer laser keratectomy for hyperopia
Received 27 April 1998; accepted 31 August 1998.
Abstract
Objective
To describe a new, rare clinical complication after routine excimer laser photorefractive keratectomy to correct hyperopia.
Design
Case report with clinicopathologic correlation.
Main outcome measures
Four weeks after treatment with excimer laser, a perforating keratoplasty was performed for persistent corneal opacities. The corneal button was examined using light and electron microscopy. Special immunohistochemical stains were used to detect apoptosis.
Results
The patient developed corneal opacities, endothelial precipitates, and a fibrinous exudate in the anterior chamber after the laser treatment. The changes did not respond to therapy directed against bacteria, fungi, and Acanthamoeba. All examinations and special stains were negative for micro-organisms. By light microscopy, an anterior zone of corneal necrosis was present with a moderate amount of acute inflammatory cells. At the interface between necrotic and viable corneal stroma, keratocytes with typical features of apoptosis were detected by immunohistochemistry and electron microscopy.
Conclusion
This is the first full histopathologic report of a case of acute corneal necrosis with signs of apoptosis after excimer laser therapy of the cornea. Surgeons should be aware of this rare but potentially severe complication.
Manuscript no. 98217.
1Department of Ophthalmology, University of Cologne, Cologne, Germany
2Alfried-Krupp-Laboratories, Department of Ophthalmology, University of Bonn, Bonn, Germany
Address correspondence to Holger Mietz, MD, Department of Ophthalmology, University of Cologne, 50924 Koeln, Germany
ABSTRACT