title: Peripheral Ulcerative Keratitis following Laser in situ Keratomileusis.
abstract: OBJECTIVE
  We report a case of a patient with a history of glomerulonephropathy, not disclosed prior to laser in situ keratomileusis (LASIK), who developed severe postoperative peripheral ulcerative keratitis (PUK) soon after surgery.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  Within a week of surgery, the patient, who had no blepharitis or ocular surface disease, also developed diffuse lamellar keratitis (DLK) that was not contiguous with the PUK. Microbiologic evaluation of the flap interface disclosed no organisms, and no epithelial ingrowth was found. Both PUK and DLK resolved with topical and oral steroid therapy, and the patient's induced refractive error improved over the 12 months following LASIK.
  
  
  CONCLUSIONS
  Necrotizing keratitis has been described after LASIK surgery in patients with or without autoimmune disease. However, to our knowledge, there has been no case of PUK following LASIK. As shown by our patient's clinical course and the typical association of PUK with systemic conditions, patients with a history of atypical postinfectious sequelae may require additional preoperative counseling, vigilant postoperative monitoring, and possibly additional intervention. Because patients do not always divulge medical details, especially if an extraocular site was involved or illness occurred many years prior, this case demonstrates the importance of performing a diligent history that excludes autoimmune disorders or atypical postinfectious sequelae prior to proceeding with keratorefractive intervention.
authors.affiliation: Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Md., USA.
authors.forename: Bryn M
authors.initials: BM
authors.lastname: Burkholder
authors.affiliation: Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Md., USA.
authors.forename: Irene C
authors.initials: IC
authors.lastname: Kuo
keywords: Autoimmune disease; In situ keratomileusis; Necrotizing keratitis; Peripheral ulcerative keratitis; Postinfectious complication; Surgically induced keratitis