Case study: Diclofenac, diabetes may have played role in PRK complication

Prolonged use of diclofenac after photorefractive keratectomy in a patient with diabetes may have been responsible for a corneal perforation, a case study suggests.

Eric Gabison, MD, and colleagues at the Fondation Ophthalmologique A. de Rothschild in Paris described the case of a 50-year-old man who developed a corneal perforation 2 months after PRK. Slit-lamp exam showed a 4-mm diameter area of central corneal thinning with a 2-mm diameter perforation at the center. The patient, who had used topical diclofenac for more than 2 months after his PRK, had a 10-year history of well-controlled diabetes. Systemic autoimmune disease was ruled out, and a penetrating keratoplasty was performed.

Results of immunohistochemical studies of the corneal button showed stromal accumulation of temporary type 3 and 4 collagens, matrix metalloproteinase (MMP)-3 and MMP-9 in the anterior wounded stroma and MMP-9 in the basal corneal epithelial cells of the leading edge.

The authors suggest that MMP-3 and MMP-9 might be involved in delayed wound closure and corneal melting.

The study is published in the August issue of Ophthalmology.