Intermittent Pain and Blur After PRK
This patient was told nothing could be done about a nodular, keloid-type subepithelial scar.
Abi Tenen, MBBS (Hons), FRANZCO; Andrea Ang, MBBS (Hons), MPH, FRANZCO; Dena Ballouz, MD; Parag A. Majmudar, MD; Allon Barsam, MA(Cantab), MBBS, FRCOphth, FWCRS; and Marguerite B. McDonald, MD, FACS
Cataract and Refractive Surgery Today 
KEY TAKEAWAYS Surgeons consider how to manage persistent intermittent pain, blurred vision, and foreign body sensation in an eye with a nodular, keloid-type subepithelial scar 8 years PRK Initial steps in this situation include optimization of the ocular surface Recurrence is possible, so patients should be counseled accordingly CASE PRESENTATION A 36-year-old woman presents with pain, blurred vision, and foreign body sensation in her left eye. Eight years ago, she underwent bilateral PRK for myopia and high astigmatism by another surgeon. The patient has experienced these symptoms intermittently since the surgery, and they have neither improved nor worsened. She was told that the left cornea has a scar and that nothing further can be done. On examination, the patient’s UCVA is 6/7.5+2 OD, 6/9.5+2 OS, and 6/6 with both eyes open. Her manifest refraction is 0 -0.75 x 50º = 6/6 OD and -0.25 -1.25 x 20º = 6/6 OS. The IOP is 10 mm Hg OD and 12 mm Hg OS. A slit-lamp examination of the left eye finds a nodular, keloid-type subepithelial scar with surrounding haze in the paracentral cornea. A reactive ptosis and brow overaction are also present on the left. The right cornea exhibits mild central haze.
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