Central Toxic Keratopathy
Central toxic keratopathy is a rare, acute, noninflammatory central corneal opacification that can occur within days after uneventful LASIK or PRK (Fig 6-4). The etiology is unknown but may be related to enzymatic degradation of keratocytes.
Confocal microscopy has demonstrated activated keratocytes without inflammatory cells, with initial keratocyte loss from the stromal bed and gradual repopulation over time. Central toxic keratopathy has been reported to result in anterior curvature flattening without alteration of posterior curvature in anterior segment tomography; however, some cases do appear to alter all tomographic findings, likely as measurement artifact. The onset is acute without worsening over time, unlike in most other interface entities.
Figure 6-4 Clinical photograph of central toxic keratopathy, a rare, acute, noninflammatory central corneal opacification that can occur within days after uneventful LASIK or photorefractive keratectomy.
(Courtesy of Parag Majmudar, MD.)
Marked hyperopic shift is often observed and tends to resolve over time. Enhancement can be deferred in these cases until refractive stability is achieved and the clinical findings have resolved. The use of topical hypertonic solutions for the treatment of central toxic keratopathy has been proposed in anecdotal reports.
Moshirfar M, Hazin R, Khalifa YM. Central toxic keratopathy. Curr Opin Ophthalmol. 2010; 21(4):274–279.
Thornton IL, Foulks GN, Eiferman RA. Confocal microscopy of central toxic keratopathy. Cornea. 2012;31(8):934–936.
Excerpted from BCSC 2020-2021 series: Section 13 - Refractive Surgery. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.