title: Toxic keratolysis from combined use of nonsteroid anti-inflammatory drugs and topical steroids following vitreoretinal surgery.
abstract: OBJECTIVE
  To evaluate the corneal complications associated with the combined use of non-steroid anti-inflammatory drugs (NSAIDs) and topical steroids following vitreoretinal surgery.
  
  
  METHODS
  Description of corneal lesions in three patients after vitrectomy with use of topical ketorolac and prednisolone acetate.
  
  
  RESULTS
  Three eyes of three patients developed an atrophic central corneal ulcer with stromal thinning following a pars plana vitrectomy under local anesthesia. Lesions were asymptomatic and were found during a routine examination 2, 3, and 8 weeks after surgery, respectively. Surgical indications were as follows: a preretinal membrane, choroidal neovascularization, and massive uveal effusion following cataract surgery. Topical postoperative treatment was as follows: ketorolac 4 times a day, a combination of prednisolone acetate, polymyxin B, and neomycin 6 times a day, and 1% cyclopentolate 3 times a day. Suspension of ketorolac and ocular occlusion led to the resolution of corneal lesions between 2.5 and 3 months later, yielding a central superficial scarring, which showed no changes after a follow-up of 3 years.
  
  
  CONCLUSIONS
  Toxic keratolysis may appear as a secondary effect of the combined use of topical NSAIDs and steroids following vitreo retinal surgery and must be taken into account in the differential diagnosis of postoperative corneal lesions.
authors.affiliation: Departamento de Cirugia Vitreoretiniana, Vissum Madrid, Santa Hortensia 58, 28002 Madrid, Spain.
authors.forename: M T
authors.initials: MT
authors.lastname: Alvarez
authors.forename: M S
authors.initials: MS
authors.lastname: Figueroa
authors.forename: M A
authors.initials: MA
authors.lastname: Teus
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D001284:Atrophy; D020256:Choroidal Neovascularization / Q000209:etiology / Q000601:surgery; D003315:Cornea / Q000187:drug effects* / Q000473:pathology; D003320:Corneal Ulcer / Q000139:chemically induced*; D003519:Cyclopentolate / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D019773:Epiretinal Membrane / Q000209:etiology / Q000601:surgery; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D020910:Ketorolac / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009355:Neomycin / Q000627:therapeutic use; D018918:Phacoemulsification / Q000009:adverse effects; D011112:Polymyxin B / Q000627:therapeutic use; D011239:Prednisolone / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D014603:Uveal Diseases / Q000209:etiology / Q000601:surgery; D014821:Vitrectomy
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; C009935:prednisolone acetate; D011239:Prednisolone; D009355:Neomycin; D003519:Cyclopentolate; D011112:Polymyxin B; D020910:Ketorolac