Nepafenac-associated Bilateral Corneal Melt After Photorefractive Keratectomy

Purpose: We are reporting a case of bilateral corneal melt after photorefractive keratectomy requiring bilateral corneal transplantations. Results: A 35-year-old man underwent uncomplicated photorefractive keratectomy and was treated postoperatively with topical nepafenac, one drop in both eyes every 2 hours. Three days into this course of treatment, the patient developed bilateral irritation and the dose was decreased to one drop every 4 hours. The next day, he developed stromal melting in both eyes. Although nepafenac was discontinued at this point, the ulcerative keratolysis progressed in both eyes requiring penetrating keratoplasty. Conclusions: We report a case of sterile ulceration after photorefractive keratectomy surgery, which we believe was caused by frequent postoperative dosing of nepafenac.