Salzmann's-like nodular degeneration following laser in situ keratomileusis

Abstract

We report the development of bilateral Salzmann's-like corneal lesions located at the site of laser in situ keratomileusis (LASIK) flap margins in 2 patients. These lesions resulted in ocular surface irritation as well as induction of irregular astigmatism and associated loss of best corrected visual acuity. Both patients had bilateral LASIK before the occurrence of the corneal lesions. A biopsy was performed on 1 nodule. The epithelium overlying this raised bluish-white corneal lesion appeared irregular in thickness, with replacement of Bowman's layer by periodic acid-Schiff positive thickened basement membrane-like material. Underlying this basement membrane was a layer of relatively regular, hypocellular, collagenlike connective tissue, which demonstrated hyalinization on trichrome staining. Based on these 2 cases, it seems possible that the hyposecretion of tears, decreased blink rate, and Dellen effect that often occur following LASIK could produce the corneal irritation needed to induce Salzmann's nodular degeneration.

Bilateral Salzmann-like nodular corneal degeneration after laser in situ keratomileusis imaged with anterior segment optical coherence tomography and high-frequency ultrasound biomicroscopy

“…Similar to the 2 patients in the Moshirfar et al 4 article with Salzmann-like nodules after LASIK surgery, our patient had chronic complaints of dry, irritated eyes preceding the appearance of the corneal nodules. Current theories regarding the etiology of Salzmann nodular degeneration speculate that lesions develop from chronic corneal irritation, often secondary to tear-film changes, corneal exposure, and uneven corneal surfaces.…”

“…Current theories regarding the etiology of Salzmann nodular degeneration speculate that lesions develop from chronic corneal irritation, often secondary to tear-film changes, corneal exposure, and uneven corneal surfaces. 2,4 All these situations apply to LASIK patients who often have exacerbation of dry eye post surgery secondary to corneal sensory nerve disruption, decreased blink rate, microkeratome-related crush of goblet cells, and a potential dellen-like interface between the posterior eyelid and the newly flattened corneal surface. 1,5 Although dry eye may not be ruled out as the solitary cause of our patient's Salzmann-like nodules, the location of the nodules within the lamellar flap interface suggests the LASIK surgery played an important role in the nodules' development.…”

“…[1][2][3] To our knowledge, only one study has associated laser in situ keratomileusis (LASIK) surgery and Salzmann nodular degeneration. 4 We report a case that further illustrates this rare complication of LASIK surgery and demonstrates the characteristics on anterior segment optical coherence tomography (OCT) and high-frequency ultrasound biomicroscopy (UBM).…”

Salzmann nodular degeneration associated with epithelial ingrowth after LASIK treated with superficial keratectomy

“…Some authors have speculated that exacerbation of dry eye syndrome contributes to the formation of Salzmann nodules after LASIK 1 2. Although dry eyes cannot be ruled out as a solitary cause in our patient, the lack of significant clinical findings of dry eye syndrome (including punctate epithelial erosions), the unilaterality of the nodules and the distribution of the nodules overlying the epithelial ingrowth lead us to hypothesise that the presence of epithelial ingrowth itself was a contributing factor.…”

Salzmannsche noduläre Hornhautdegeneration

“…Ihr exakter Anteil ist meist nicht zu erkennen. Es gibt aber relativ viele, z. T. auch unter anderem Titel versteckte Einzelfalldarstellungen mit unterschiedlichsten Ätiologie-hinweisen [1,10,11,22,24,27,29,30,34,35,48]. Von der typischen Salzmann-Dystrophie unter-1 "In der Tat findet sich bei Weitem nicht in allen Fällen eine phlyktänuläre Ursache für diese Dystrophie."…”