Corneal Ring Infiltrate Following Micropulse Cyclophotocoagulation

BACKGROUND We report a case of neurotrophic keratopathy (NK) following micropulse cyclophotocoagulation (MP-CPC), presenting as a ring infiltrate. We describe this clinical presentation after MP-CPC with diagnostic challenges. We provide an approach to how a proper diagnosis was reached and highlight the importance of preoperative assessment of corneal surface health in patients at risk. CASE REPORT A 36-year-old diabetic woman was referred to our cornea clinic for a new onset of a ring infiltrate in her right eye, after undergoing MP-CPC for an uncontrolled neovascular glaucoma. She had no pain or discharge, but was bothered by photophobia. After obtaining a proper medical history, best corrected visual acuity was 3/200 in the affected eye, corneal sensitivity was reduced, and slit lamp examination showed a large inferior corneal epithelial defect with a peripheral anterior stromal ring infiltrate. Corneal scrapings were obtained and differential diagnoses were excluded until a proper diagnosis of NK was reached. As conservative medical treatment with prophylactic antibiotics and frequent lubricating eye drops failed to achieve complete healing of the epithelial defect, amniotic membrane grafting was performed and resulted in complete healing with residual corneal scarring. CONCLUSIONS Neurotrophic keratopathy presenting as a corneal ring infiltrate can be confused with infectious keratitis and result in diagnostic challenges. As cases of NK after MP-CPC are more frequently reported, a routine preoperative assessment of corneal sensation is recommended, especially in patients at risk, such as diabetics. Preoperative counselling, customized treatment protocols such as shortening the treatment time, and close monitoring of postoperative ocular surface health should be implemented following MP-CPC to prevent the occurrence of serious ocular complications such as corneal scarring, melting, or perforation.