Crystalline Keratopathy in Post-LASIK Ectasia: A Case Report

PURPOSE: To report an unusual case of bilateral crystalline keratopathy presenting several years after a laser in situ keratomileusis (LASIK) procedure. METHODS: Case report and review of the literature. RESULTS: A healthy 42-year-old woman with post-LASIK ectasia, treated with long-term corneoscleral contact lenses, developed new-onset crystalline keratopathy in both eyes. Anterior segment optical coherence tomography demonstrated bilaterally symmetric paracentral rings of hyperreflectivity, involving the LASIK corneal flaps. There was good clearance of the corneoscleral contact lenses with no corneal-lens touch in all quadrants. There was no evidence of infectious or systemic etiologies. Genetic testing for the UBIAD1 gene for Schnyder corneal dystrophy was negative. Continued clinical observations have exhibited progressive corneal crystalline deposition, yet the patient has remained visually asymptomatic. CONCLUSIONS: This is the first known reported case of significantly delayed progressive noninfectious crystalline keratopathy in post-LASIK ectasia. The pathophysiology of this condition remains elusive to date and highlights the challenges of noninvasive diagnostic techniques and yet the utility of molecular genetic analysis in elucidating the etiology of this unique clinical presentation.