Central Toxic Keratopathy after Photorefractive Keratectomy: Two-Year Follow-Up Case Report and Review of the Literature.

PURPOSE: To report a rare case of central toxic keratopathy (CTK) after photorefractive keratectomy (PRK).

METHODS

A 22-year-old male underwent bilateral PRK for the correction of myopic astigmatism. Preoperative refraction measurements were -2.50 -1.00 × 65 in the right eye and -3.50 diopter (D) sphere in the left eye. The intended refractive correction was -3.25 -1.00 × 65 (in the right eye) and -4.25 D sphere in the left eye. Preoperative corneal thickness measured 489 μm (in the right eye) and 491 μm in the left eye, both values exceeding the minimum safe threshold for PRK.

RESULTS

At the 1-week postoperative evaluation, slit-lamp examination and optical coherence tomography (OCT) revealed significant central corneal haziness, thinning, and flattening, along with hyperopic astigmatism. These findings were consistent with CTK. The surgeon adopted a conservative approach, closely monitoring the patient without initiating pharmacological intervention. By the 6-month follow-up, the patient demonstrated reduced hyperopia and achieved a best-corrected visual acuity of 20/20. OCT imaging also confirmed increased central corneal and epithelial thickness, suggesting progressive recovery. Long-term follow-up over 2 years showed stable refraction and corneal thickness, with no further significant changes.

CONCLUSIONS

CTK is a rare but vision-threatening complication of refractive surgery, occurring not only after laser in situ keratomileusis but also following other refractive surgery approaches. Enhancing clinical knowledge of both its presentation and differential diagnosis is essential to avoid any unnecessary interventions.