Late onset bilateral annular subepithelial corneal haze after LASIK

Corneal haze is uncommon after laser assisted in situ keratomileusis (LASIK). Post-LASIK haze and scarring can develop due to different conditions such as infectious keratitis, LASIK flap complications, diffuse lamellar keratitis (DLK), corneal photo disruption and damage to the basement membrane due to effects of femtosecond laser, or unknown causes such as in central toxic keratopathy (CTK). In this report, we describe a patient with bilateral late onset annular subepithelial corneal haze which presented more than 20 years after LASIK.

A 65-year-old woman who presented with decreased vision in both eyes (Best corrected visual acuity [BCVA] 20/80 in right eye and 20/300 in the left eye) over 20 years after LASIK. The patient had history of gout, chromic kidney disease, dry eyes, and chronic cigarette smoking. Clinical examination and anterior segment optical coherence tomography revealed bilateral annular subepithelial corneal haze in the paracentral and midperipheral zone in an annular pattern. Following superficial keratectomy and mitomycin-C application, the uncorrected corrected visual acuity improved to 20/60 in the right eye at 7 months but the final BCVA decreased to 20/300 at 11 months after the surgery due to recurrence of subepithelial haze. The postoperative BCVA improved to 20/30 in the left eye 7 months after the surgery. Histologic examination of the excised corneal tissue revealed presence of subepithelial fibrous tissue and epithelial basement membrane thickening.

Although uncommon, delayed onset bilateral annular subepithelial haze and scarring can develop after LASIK. Although the reason for this clinical presentation is unknown, it is possible that chronic ocular surface breakdown due to a combination of systemic and local factors such as gout, chronic kidney disease, dry eyes, and chronic cigarette smoking contributed to development of subepithelial haze in this patient.