Sir,

Arcuate keratotomy is a common procedure after keratoplasty, but can induce central corneal haze in eyes with a history of PRK. Herein, we report on a patient with the history of uncomplicated penetrating corneal transplantation with uncomplicated PRK, who developed central corneal haze 6 months after wedge resection.1

Case report

A 34-year-old man with keratotconus underwent penetrating keratoplasty in the right eye in 1993 and arcuate keratotomies (AK) for high astigmatism in 2000. A PRK for a refraction of −1.0 × −2.0/140° without mitomycine C (MMC) was done in 2005.

Postoperative course was uncomplicated including a clear cornea and uncorrected distance visual acuity (UDVA) was 0.2 logMAR 6 months after PRK. The patient's vision decreased 5 years later again due to inferior corneal steepening and wedge resection (two opposite 60° AK in the 6.0-mm central optical zone with six compression sutures using 10-0 nylon) was performed to treat irregular astigmatism.

The cornea developed severe central haze with decrease of vision to 2.0 logMAR with a refraction of −1.0≈−2.5/180 6 months later (Figure 1a).

Figure 1
figure 1

(a) Severe corneal haze of the patient 9 months after wedge resection. (b) The same cornea 18 months after a single application of MMC to the scarred area.

Full size image

MMC 0.02% was applied therefore as a therapeutic option for 45 s on a sponge after epithelial removal.2 Haze disappeared 4 months later and UDVA increased to 0.2 logMAR. The cornea remained clear for the follow-up period of 21 months (Figure 1b).

Comments

Haze formation is possible in the central cornea after incisional surgery in eyes with a history of PRK, even if the cornea was clear.

However, lamellar transplantation has been described as therapeutic option for visual recovery in such cases,3 but this case shows that a single topical application of MMC 0.02% for 45 s is a suitable treatment option and the cornea remained clear for the entire postoperative follow-up period of 21 months.

Incisional surgery is a risk factor for eyes with a history of PRK, but MMC 0.02% application is a useful therapeutic option for the removal of corneal haze.