Wessely immune rings following Keratorefractive Lenticule extraction: A case-based review

Purpose To describe two cases of immune-mediated corneal stromal infiltrates resembling Wessely immune rings following keratorefractive lenticule extraction (KLEx). Observations The first patient developed bilateral peripheral ring-shaped stromal infiltrates on postoperative day four, raising initial concern for infectious keratitis. Negative microbiologic work-up and favorable response to corticosteroids confirmed an immune-mediated etiology. The second patient presented with a unilateral peripheral stromal infiltrate on postoperative day one, which resolved with topical and subconjunctival corticosteroid therapy. In both cases, visual acuity improved to 20/20 without long-term sequelae. Conclusions and importance Wessely immune rings may develop after KLEx, mimicking infectious keratitis in the early postoperative period. Prompt recognition and differentiation of immune-mediated reactions from infections are essential to avoid unnecessary antimicrobial therapy and achieve favorable visual outcomes.