Bleeding Under an Established Laser-Assisted In Situ Keratomileusis (LASIK) Flap

      A 45-year-old man who had LASIK 2 decades ago presented with 5 days of painless decreased vision in his left eye. Presenting visual acuity was 20/400 uncorrected (baseline unavailable); there was blood in the lower half of the flap interface (Fig A, white arrows), subepithelial fibrosis, and corneal neovascularization (black arrow). After 1 week of treatment with topical difluprednate 0.05% 4 times per day and oral valacyclovir, flap interface blood was stable (Fig B). Six weeks after presentation (Fig C), he was 20/30-2 uncorrected with mild irregular astigmatism along with trace residual blood and pannus. The suspected etiology was herpes simplex virus–mediated interstitial keratitis. (Magnified version of Fig A-C is available online at
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