Histopathology of corneal melting associated with diclofenac use after refractive surgery

Joseph K.W. Hsu, W. Todd Johnston, Russell W. Read, Peter J. McDonnell, Rey Pangalinan, Narsing Rao, Ronald E. Smith

Research output: Contribution to journalArticle

Abstract

Purpose: To describe the histopathology of the cornea in 3 cases of corneal melting associated with diclofenac therapy after refractive surgery procedures. Setting: Clinic and pathology laboratory. Methods: Three cases of corneal melting associated with diclofenac therapy (2 after laser in situ keratomileusis [LASIK] and 1 after mini-radial keratectomy enhancement of a LASIK undercorrection) were studied using patient and referring physician interviews, chart reviews, and histopathologic examination of the corneal tissue. Results: In all 3 cases, the flaps were dislocated and the stromal corneal bed was exposed. Diclofenac, generic or brand name, was used in all cases; in 1 case, both generic and brand name were used. Dosing and duration varied, but in all 3 cases diclofenac was used at least 4 times a day for at least 3 days after LASIK. Topical steroids were also prescribed, but 1 patient did not use them. Preoperative medical conditions were present in 2 cases. Histologic analysis showed evidence of an inflammatory response in advanced cases and keratolysis and lack of inflammatory cells in the flaps that were amputated early. Conclusions: The use of generic or brand-name diclofenac with or without adjunctive topical steroids after LASIK can be associated with corneal melting when the LASIK flap is dislodged and the corneal stromal bed exposed. Caution is recommended with diclofenac use after LASIK in such cases.

Original languageEnglish (US)
Pages (from-to)250-256
Number of pages7
JournalJournal of cataract and refractive surgery
Volume29
Issue number2
DOIs
StatePublished - Feb 1 2003

    Fingerprint

ASJC Scopus subject areas

  • Surgery
  • Ophthalmology
  • Sensory Systems

Cite this