Acute corneal necrosis after excimer laser keratectomy for hyperopia

Area of Science:

• Ophthalmology
• Corneal Surgery
• Laser Vision Correction

Background:

• Excimer laser photorefractive keratectomy (PRK) is a common procedure for hyperopia correction.
• While generally safe, rare complications can occur, necessitating thorough investigation.

Observation:

• A patient developed persistent corneal opacities and anterior chamber inflammation post-PRK.
• Standard antimicrobial and anti-amoebic therapies were ineffective.
• Corneal tissue analysis revealed necrosis and apoptosis of keratocytes.

Findings:

• Histopathology confirmed acute corneal necrosis with inflammatory cell infiltration.
• Immunohistochemistry and electron microscopy demonstrated characteristic features of apoptosis in keratocytes at the necrotic-viable tissue interface.
• Microbial and Acanthamoeba infections were ruled out.

Implications:

• This report presents the first histopathologic evidence of acute corneal necrosis with apoptosis following excimer laser PRK.
• Ophthalmologists should be aware of this rare but severe complication.
• Understanding the mechanism of keratocyte apoptosis may inform future strategies to mitigate risks associated with laser corneal surgery.