Laser-assisted intrastromal keratomileusis in a patient with systemic mastocytosis

The U.S. Food and Drug Administration (FDA), and more recently the American Academy of Ophthalmology (AAO), list relative and absolute contraindications to laser-assisted intrastromal keratomileusis (LASIK). The AAO guidelines consider connective tissue or autoimmune diseases and systemic immunosuppresion as relative contraindications and only uncontrolled diseases and uncontrolled ocular allergy as absolute contraindications. Recent reports concluded that LASIK could be performed effectively and safely in selected patients with stable and controlled systemic diseases. Reported here is a case of successful LASIK with 3 years follow-up in the setting of systemic mastocytosis.

A 42-year-old woman with moderate myopia and astigmatism underwent bilateral LASIK. Her medical history was significant for systemic mastocytosis. Five days after surgery, a diffuse lamellar keratopathy (DLK) 1+ was observed in the left eye and treated successfully with prednisolone acetate. The patient achieved visual acuity of 20/20 in each eye unaided. These findings were stable at 7, 12, 18, and 36 months after surgery. She continues to use olopatadine.

Because of the rare nature of systemic mastocytosis and the anaphalactoid mechanism of release of mast cells, it may be difficult to assess the risk of undergoing LASIK. Any known or suspected triggers must be avoided. The use of an antihistamine and mast cell stabilizer, as used in this case, may have a beneficial effect.