Delayed Laser In Situ Keratomileusis Interface Haze 6 Months After Corneal Cross-linking for Ectasia

Abstract

PURPOSE: To report a case of delayed subepithelial haze at the laser in situ keratomileusis (LASIK) flap interface after corneal cross-linking (CXL) for LASIK-induced ectasia. METHODS: A 39-year-old woman with ectasia after LASIK underwent accelerated CXL with riboflavin and hydroxypropyl methylcellulose every 2 minutes for 20 minutes, then ultraviolet light at a fluence of 10 mW/cm 2 for 9 minutes. Outcomes measured included stromal haze assessment and visual refractive parameters. Follow-up was conducted using slit-lamp imaging, optical coherence tomography (OCT), corneal topography, and a dedicated OCT image analysis software. RESULTS: Six months after CXL, OCT of the right eye showed a sharply demarcated hyperreflective linear lesion inferotemporal to the corneal center, at the LASIK flap interface. The haze was 1.5-mm wide with 12.49 grayscale units (GSU) intensity and involved the anterior stroma at 0.9 mm away from the center extending from 225° to 255°. This haze peaked at 9 months after CXL, reaching 3 mm in size and 29.01 GSU in intensity. Corneal topography showed steepening on the haze area and flattening on the diametrically opposite side. Topical steroid therapy was initiated. At final evaluation (19 months), there was a significant decrease in haze reflectivity and size, accompanied by marked improvement of the topography. CONCLUSIONS: Delayed corneal haze after CXL with a history of LASIK can develop at the level of the LASIK interface right under the cone area. Although it was responsive to topical steroid therapy, the reasons for this clinical presentation are still unknown. [ Journal of Refractive Surgery Case Reports. 2022;2(2):e46–e50.]