Management of Bilateral Central Toxic Keratopathy and Coinfection With Atypical Mycobacteria in One Eye After Simultaneous Bilateral Photorefractive Keratectomy

We report on the management of a patient with bilateral central toxic keratopathy (CTK) and infective keratitis in one eye after bilateral photorefractive keratectomy (PRK). A 27-year-old woman presented with bilateral central corneal opacification, thinning and reduced vision within a week of PRK. The uncorrected distance visual acuity was 20/100 in the right eye and 20/60 in the left eye. The central pachymetry was 296 μm in the right eye and 262 μm in the left eye. Clinical diagnosis of CTK was made. Initial treatment included oral doxycycline and vitamin C. Subsequent evaluation at 3 weeks post-PRK showed infiltrate in the left eye, which revealed atypical mycobacteria on microbiological tests. The left eye was treated with topical azithromycin 1% for 2 months with a favorable response. The central pachymetry in the right eye improved significantly in 3 months. At 4 months, the central pachymetry in the right eye restored to 420 μm, which was stable till the last follow-up of 1 year. The central pachymetry in the left eye improved to 373 μm in 8 months, which remained stable till 1-year follow-up. At 1 year, the best corrected visual acuity was 20/20 and 20/25 in the right and left eyes, respectively. Bilateral CTK associated with infective keratitis in one eye can be effectively treated with medical therapy. Central toxic keratopathy may be self-limiting, requiring supportive management. Prompt recognition of coexisting infection and timely management leads to good visual outcomes.