Aggressive pterygium growth and corneal scarring after hyperopic photorefractive keratectomy

To describe a patient who noticed a corneal growth and accompanying rapid decrease in visual acuity soon after undergoing hyperopic photorefractive keratectomy (PRK).

Interventional case report.

A healthy 47-year-old white woman presented with a corneal growth after undergoing PRK. Visual acuity became progressively worse over 2 years. The growth transected the visual axis, measuring 180 μm centrally and 310 μm nasally. She underwent excisional biopsy, application of mitomycin C on the limbus and adjacent corneal tissue, and grafting with cryopreserved multilayer amniotic membrane. The pathologist reported findings consistent with pterygium. The patient initially experienced improvement in uncorrected visual acuity but then became noncompliant with topical steroids. The central anterior stroma became opacified to the extent of obscuring iris details. Best-corrected visual acuity at the last follow-up was 20/30.

Because ultraviolet exposure is a risk factor for development and growth of pterygium, 1 possible explanation for this patient's findings is the effect of the excimer laser (which has a wavelength in the ultraviolet spectrum) on a previously insignificant corneal growth and/or the corneal limbal stem cells. Patients with corneal lesions suggestive of pterygia may be at increased risk for rapid lesion growth and aggressive corneal scarring after photorefractive keratectomy with a large ablation zone.