Central Toxic Keratopathy after Photorefractive Keratectomy: A Four-Year Case Report

Introduction: Central toxic keratopathy (CTK) is an uncommon, non-inflammatory opacification of the central cornea after excimer laser refractive surgery, usually within the first postoperative week. The cornea loses central stromal tissue and flattens, and the eye becomes hyperopic. Why it happens is not known; both surgical contaminants and an immune-mediated process have been proposed. Methods: We describe a 26-year-old male physician who underwent bilateral photorefractive keratectomy (PRK) for refractive correction before applying for military service. Results: One week after surgery he had central corneal haze in both eyes, with topographic flattening and a large hyperopic astigmatic shift that was worse in the right eye. He was treated medically: the topical corticosteroid was intensified and topical cyclosporine was added. Over 16 months of follow-up the left eye recovered completely, while the right eye recovered partially and settled at an uncorrected distance visual acuity of 0.8 with faint residual paracentral haze. At four years the corneas remained stable and the visual result unchanged, without further surgical intervention. Conclusion: CTK is rare, but the visual loss in the first week after PRK can be severe. Recognizing it early matters, because the alternatives are an unnecessary antimicrobial course or an unnecessary operation. With close follow-up the long-term outlook is good, and patients deserve to hear about this complication before they consent to refractive surgery.