Myopic regression and recurrent Salzmann nodule degeneration after laser in situ keratomileusis in Ehlers Danlos Syndrome

Grant C Hopping; Anisha N Somani; Uma Vaidyanathan; Harry Liu; James R Barnes; Yasmyne C Ronquillo; Phillip C Hoopes; Majid Moshirfar

doi:10.1016/j.ajoc.2020.100729

Myopic regression and recurrent Salzmann nodule degeneration after laser in situ keratomileusis in Ehlers Danlos Syndrome

Am J Ophthalmol Case Rep. 2020 May 4:19:100729. doi: 10.1016/j.ajoc.2020.100729. eCollection 2020 Sep.

Authors

Grant C Hopping¹, Anisha N Somani¹, Uma Vaidyanathan¹, Harry Liu¹, James R Barnes², Yasmyne C Ronquillo³, Phillip C Hoopes³, Majid Moshirfar^{3

4

5}

Affiliations

¹ McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin St, Houston, TX, 77030, USA.
² Virginia Commonwealth University School of Medicine, VCU Medical Center, 1201 E, Marshall St #4-100, Richmond, VA, 23298, USA.
³ Hoopes Durrie Rivera Research Center, Hoopes Vision; 11820 State St, Draper, UT, 84020, USA.
⁴ Utah Lions Eye Bank; 6056 Fashionsquare Drive Suite 200, Murray, UT, 84107, USA.
⁵ John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine; 65 Mario Capecchi Drive Salt Lake City, UT, 84132, USA.

Abstract

Purpose: We describe the first case of Ehlers Danlos Syndrome (EDS) reported in the English language ophthalmic literature to have undergone Laser In Situ Keratomileusis (LASIK) surgery.

Observations: We review our patient's specific postoperative complications of myopic regression, Salzmann nodular degeneration, and dry eye syndrome, as well as the risks and consequences of performing LASIK on patients with this collagen disorder.

Conclusions and importance: Refractive errors may prompt EDS patients to seek laser vision correction, placing them at increased risk for complications such as myopic regression, keratectasia, and dry eye syndrome. Aberrant wound healing and collagen dysfunction may have influenced our patient's myopic regression and Salzmann nodule degeneration post-LASIK. Currently, EDS is considered a relative contraindication in LASIK due to a presumed higher risk of postoperative keratectasia; however, we believe it is possible that not all forms of EDS need to be an absolute contraindication to LASIK. More research is warranted to determine preoperative risk stratification for laser vision surgery in each subtype of EDS.

Keywords: Ehlers danlos; Keratoconus; LASIK; Myopia; Salzmann nodule; dry eye syndrome.

Publication types

Case Reports