title: Histopathology of corneal melting associated with diclofenac use after refractive surgery.
abstract: OBJECTIVE
  To describe the histopathology of the cornea in 3 cases of corneal melting associated with diclofenac therapy after refractive surgery procedures.
  
  
  METHODS
  Clinic and pathology laboratory.
  
  
  METHODS
  Three cases of corneal melting associated with diclofenac therapy (2 after laser in situ keratomileusis [LASIK] and 1 after mini-radial keratectomy enhancement of a LASIK undercorrection) were studied using patient and referring physician interviews, chart reviews, and histopathologic examination of the corneal tissue.
  
  
  RESULTS
  In all 3 cases, the flaps were dislocated and the stromal corneal bed was exposed. Diclofenac, generic or brand name, was used in all cases; in 1 case, both generic and brand name were used. Dosing and duration varied, but in all 3 cases diclofenac was used at least 4 times a day for at least 3 days after LASIK. Topical steroids were also prescribed, but 1 patient did not use them. Preoperative medical conditions were present in 2 cases. Histologic analysis showed evidence of an inflammatory response in advanced cases and keratolysis and lack of inflammatory cells in the flaps that were amputated early.
  
  
  CONCLUSIONS
  The use of generic or brand-name diclofenac with or without adjunctive topical steroids after LASIK can be associated with corneal melting when the LASIK flap is dislodged and the corneal stromal bed exposed. Caution is recommended with diclofenac use after LASIK in such cases.
authors.affiliation: Doheny Eye Institute, Los Angeles, California, USA.
authors.forename: Joseph K W
authors.initials: JK
authors.lastname: Hsu
authors.forename: W Todd
authors.initials: WT
authors.lastname: Johnston
authors.forename: Russell W
authors.initials: RW
authors.lastname: Read
authors.forename: Peter J
authors.initials: PJ
authors.lastname: McDonnell
authors.forename: Rey
authors.initials: R
authors.lastname: Pangalinan
authors.forename: Narsing
authors.initials: N
authors.lastname: Rao
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Smith
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D003315:Cornea / Q000187:drug effects / Q000473:pathology*; D003316:Corneal Diseases / Q000139:chemically induced* / Q000473:pathology* / Q000601:surgery; D004008:Diclofenac / Q000009:adverse effects*; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ; D015948:Keratoplasty, Penetrating; D008297:Male; D009216:Myopia / Q000601:surgery*; D013524:Surgical Flaps / Q000473:pathology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac