Hypersensitivity reactions after femtosecond laser small incision lenticule extraction: a case report of corneal infiltrates

BACKGROUND: Femtosecond laser corneal refractive surgery is generally considered safe and effective; however, this procedure is rarely associated with severe allergic reactions. We reported a rare case of hypersensitivity reactions which caused bilateral peripheral corneal infiltrates after femtosecond laser small incision lenticule (SMILE) surgery in a man with a history of fruits allergy. CASE PRESENTATION: Here we report the case of a young man who developed white, ring-shaped bilateral peripheral infiltrates that appeared 1 day after an uneventful SMILE surgery. The overlying corneal epithelium was intact; the infiltrate was negative for bacterial culture, but high titers of immunoglobulin E was demonstrated in the blood. Symptomatically, a clinical diagnosis of sterile corneal infiltrates was made, and the patient was treated with topical and systemic steroids. The infiltrates were immunogenic in origin, which may be caused by the contact lenses used for suction duration in surgery. It resolved without corneal scarring in the subsequent months following steroid treatment. The patient’s visual acuity improved. CONCLUSIONS: When patients with a history of allergy who aim to perform corneal refractive surgery, surgeons must consider possible hypersensitivity reactions after treatment. More studies are needed to clarify the relationship between contact glass used in femtosecond laser corneal refractive surgery and IgE mediated hypersensitivity reactions.