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Case Report

Penetrating Corneal Injury Under an Intact Laser-assisted in Situ Keratomileusis Flap

Maki, Sarah, MD1*; Hou, Joshua H., MD1

doi: 10.1097/OPX.0000000000001297

SIGNIFICANCE As the prevalence of post–laser-assisted in situ keratomileusis (LASIK) patients rises, recognition of possible traumatic complications and their management in this population becomes increasingly relevant. Penetrating injuries and intraocular foreign bodies are possible in post-LASIK corneas despite an intact anterior corneal surface. However, with prompt recognition and treatment, excellent visual recovery can be achieved.

PURPOSE The purpose of this study was to report an interesting case of a penetrating foreign body through an intact LASIK flap.

CASE REPORT A 48-year-old man presented to an outside provider with right eye pain after his eye was struck by a tree branch. His ocular history was notable for uncomplicated LASIK surgery 4 years before presentation. On initial examination, the patient was diagnosed as having a small corneal abrasion and hyphema. Despite appropriate therapy, his eye continued to subjectively and objectively worsen. Follow-up examination after the injury was notable for a new dense hypopyon. Because of concern for secondary infection, the patient was referred urgently for further evaluation. Upon referral, the patient was noted to have a dense, fibrinous mass located inferiorly in the anterior chamber. Although the cornea was edematous temporally with deep folds, the anterior corneal surface appeared intact without evidence of laceration or flap displacement. Concern for endophthalmitis prompted anterior chamber washout, where a large vegetative foreign body was recovered despite an intact anterior corneal surface and LASIK. Post-operative anterior-segment optical coherence tomography after resolution of the corneal edema confirmed the presence of a well-aligned penetrating tract through the posterior stromal bed underneath the LASIK flap. Epithelial ingrowth that developed within the post-operative period further affirmed the initial tract of the penetrating foreign body.

CONCLUSIONS This case illustrates a novel complication after trauma in a post-LASIK patient, describes possible management, and underscores the care that must be taken when assessing patients with a history of LASIK surgery.

1University of Minnesota, Minneapolis, Minnesota *

Submitted: February 15, 2018

Accepted: June 23, 2018

Funding/Support: None of the authors have reported funding/support.

Conflict of Interest Disclosure: There was no funding received in the production of this research. None of the authors have reported a financial conflict of interest.

Author Contributions: Investigation: JHH; Writing – Original Draft: SM; Writing – Review & Editing: SM, JHH.

© 2018 American Academy of Optometry