Successful Management Of Unilateral Subepithelial Corneal Infiltrates With Phototherapeutic Keratectomy

To report a case of unilateral subepithelial corneal infiltrates consecutive to epidemic keratoconjunctivitis successfully managed with phototherapeutic keratectomy (PTK) with satisfactory refractive and visual outcome.

Ophthalmology department of Habib Thameur Hospital in Tunis, Tunisia.

A 68-year-old man presented for a blurred vision of the right eye, 1 year after a healed episode of epidemic viral keratoconjunctivitis. Visual acuity of the right eye was reduced to 3/10, and anterior segment examination showed multiple central subepithelial corneal infiltrates and a cortical cataract. Fundus examination was normal. The left eye had a visual acuity of 10/10 and no corneal infiltrates. Anterior segment OCT (AS-OCT) of the right eye showed anterior stromal hyperreflective patchy lesions reaching a depth of 85 um, with an intact Bowman's layer and a uniform epithelial thickness.The patient underwent phototherapeutic keratectomy of the right eye with an optic zone of 8 mm and a treatment depth of 90 um. At 1-month follow-up, corrected visual acuity was at 7/10, with a slight hyperopic shift and a total resolution of adenoviral infiltrates. The patient developed a corneal haze which responded well to steroids. At 1-year follow-up, vision remained stable at 7/10.

PTK is an interesting alternative to corneal graft surgery in corneal lesions located in the superficial 100 microns of the corneal stroma. The rate of success depends on the nature, the location and the depth of the lesions. In adenoviral subepithelial infiltrates, the results are very encouraging with resolution of the infiltrates and notable improvement in vision quality. A considerable attention has to be accorded to unilateral cases like in our patient, in which hyperopic shift due to PTK treatment can lead to anisometropia. Main complications are corneal haze and ectasia which can be avoided while respecting a posterior wall of 350 to 400 microns.