title: Central toxic keratopathy: description of a syndrome in laser refractive surgery.
abstract: OBJECTIVE
  To describe the clinical spectrum of a syndrome in laser refractive surgery, which we call central toxic keratopathy, and to present cases that illustrate the range of this syndrome.
  
  
  METHODS
  Retrospective observational case series.
  
  
  METHODS
  Eyes with noninflammatory central corneal opacification in the immediate postoperative period after photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK) were identified, and the charts abstracted.
  
  
  RESULTS
  Twenty-three eyes of 14 patients were identified who developed central corneal opacification three to nine days after laser refractive surgery. Nineteen of these eyes had LASIK and four had PRK. All eyes had central corneal opacification in the area of laser treatment that extended posteriorly from the interface into the stromal bed (in the case of LASIK eyes). The opacification persisted a minimum of two months to a maximum of 18 months before clearing. Nine eyes developed postoperative hyperopia of greater than 2 diopters. Pre- and postoperative best-spectacle corrected acuity was available on 19 eyes; one of these eyes lost two lines of corrected acuity, and two other eyes lost one line. Eighteen of 19 LASIK eyes had diffuse lamellar keratitis preceding the onset of corneal opacification.
  
  
  CONCLUSIONS
  Central toxic keratopathy is characterized by noninflammatory central corneal opacification with a significant hyperopic shift. The opacification gradually clears over a period of months, leaving the eye hyperopic. Enhancement is indicated to treat residual hyperopia and remove residual striae. Topical or oral corticosteroid treatment is not indicated. The cause of central toxic keratopathy is unknown.
authors.affiliation: Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Baris
authors.initials: B
authors.lastname: Sonmez
authors.forename: Robert K
authors.initials: RK
authors.lastname: Maloney
mesh_terms: D000328:Adult; D003318:Corneal Opacity / Q000175:diagnosis / Q000209:etiology*; D003319:Corneal Stroma / Q000473:pathology*; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000175:diagnosis / Q000209:etiology*; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D054018:Lasers, Excimer; D008297:Male; D008875:Middle Aged; D018903:Photorefractive Keratectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013577:Syndrome; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology; D014792:Visual Acuity