Topical anesthesia-induced keratopathy after laser-assisted subepithelial keratectomy

• Published in: Journal of cataract and refractive surgery Vol. 33; no. 8; pp. 1482 - 1484
• Main Authors: Rao, Srinivas K., DO, DNB, FRCS, Wong, Victoria W.Y., MMedSc, MRCS, Cheng, Arthur C.K., MRCS, Lam, Philip T.H., FRCS, FRCOphth, Lam, Dennis S.C., MD, FRCS, FRCOphth
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-08-2007; Elsevier Science
• Subjects: Adult; Anesthesia, Local - adverse effects; Anesthetics, Local - adverse effects; Biological and medical sciences; Corneal Diseases - chemically induced; Corneal Diseases - surgery; Diseases of cornea, anterior segment and sclera; Female; Humans; Keratectomy, Subepithelial, Laser-Assisted; Keratoplasty, Penetrating; Medical sciences; Myopia - surgery; Ophthalmology; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Procaine - adverse effects; Procaine - analogs & derivatives; Substance-Related Disorders; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Local administration; Eye disease; Treatment; Surgery; Laser; Anesthesia; Keratopathy; Keratectomy; Ophthalmology; Anterior segment disease
• ISSN: 0886-3350; 1873-4502
• DOI: 10.1016/j.jcrs.2007.04.020

A 42-year-old woman had uneventful bilateral laser-assisted subepithelial keratectomy (LASEK) to correct myopia. She experienced intense pain in the first postoperative week and obtained topical oxybuprocaine for pain relief. Subsequently, she developed bilateral persistent corneal epithelial defects, epithelial edema, and bullae that failed to heal with bandage contact lens and topical lubricants. Over the next 4 months, there was progressive corneal stromal thinning and descemetocele formation in 1 eye, requiring application of cyanoacrylate glue, and stromal edema and scarring in the other eye, which resulted in a visual acuity of counting fingers. Investigations did not reveal associated infection or an underlying immunological disorder; however, the patient admitted to excessive use of topical anesthetic eyedrops in the post-LASEK period. She subsequently had penetrating keratoplasty and lens extraction with IOL implantation in the right eye. The left eye healed with central corneal scarring. This case illustrates that serious sight-threatening complications may occur after LASEK due to abuse of topical anesthetic agents.