The Potential Role of Topical Losartan in Reducing Subepithelial Haze in Traumatic Laser-Assisted In Situ Keratomileusis (LASIK) Flap Avulsion

We report a case of a 42-year-old woman who previously underwent femtosecond-assisted myopic laser-assisted in situ keratomileusis (LASIK) with uncorrected distance visual acuity (UDVA) 20/20- in both eyes (OU). The patient presented three months later following a motor vehicle accident (MVA), which she experienced blunt force trauma from airbag contact to the left eye (OS). In the emergency department, the patient complained of pain, decreased visual acuity, excessive tearing, and edema of the left eyelids. Slit lamp examination was consistent with a complete traumatic LASIK flap amputation OS. A bandage contact lens was placed combined with moxifloxacin eye drops. The UDVA was 20/400 OS. The patient was continued on moxifloxacin four times a day (QID) and transitioned to Tobradex drops QID at day nine with improvement in UDVA to 20/30-2. At three weeks post-MVA, the patient's visual acuity decreased to 20/100 secondary to significant corneal haze. Topical losartan 0.8 mg/mL was added six times per day along with fluorometholone two times a day (BID). Six weeks later, visual acuity was measured as 20/50-1 with improvement of central corneal haze. The patient was continued on losartan for four months with resolution of the corneal haze and improvement in UDVA to 20/30. Uncorrected visual acuity after LASIK flap amputation is generally favorable, especially if corneal haze can be prevented. Topical losartan has anti-fibrotic activity through inhibition of the transforming growth factor-beta (TGF-β) signaling pathway, and in conjunction with topical steroids, may be effective in improving corneal haze in patients with a traumatic LASIK flap amputation.