Interface fluid associated with diffuse lamellar keratitis and epithelial ingrowth after laser in situ keratomileusis

We report the confocal microscopic findings in a case of interlamellar stromal keratopathy induced by elevated intraocular pressure (IOP) after laser in situ keratomileusis (LASIK). In vivo confocal microscopy showed swollen and enlarged cellular structures and the presence of microlacunae separating the stromal collagen lamellae. Inflammatory mononuclear cells and granulocytes typically seen in patients with diffuse lamellar keratitis (DLK) were absent. Stopping the topical steroids with concurrent lowering of the IOP resulted in improvement in the uncorrected and best corrected visual acuities and was associated with resolution of the corneal findings. In vivo confocal microscopy is a useful tool to study interlamellar stromal keratopathy induced by elevated IOP after LASIK in humans and the response to treatment and to differentiate interlamellar stromal keratopathy from DLK.

“…5 Similar cases have been reported. 6,7 Belin et al 8 report a series of 4 patients in which a clinical picture identical to that of classic DLK developed.…”

Section: J Cataract Refract Surg 2006; 32:1563-1566 Q 2006 Ascrs and supporting

confidence: 75%

In vivo confocal microscopic findings of interlamellar stromal keratopathy induced by elevated intraocular pressure

Kurian

Shetty²,

Shetty³

et al. 2006

“…1,5 In this case, we report the corneal changes involved in the development of interface fluid after vitreoretinal surgery. Corneal OCT, which has been shown to monitor the corneal structures after LASIK with a high reproducibility, 6 allowed us to obtain preoperative and postoperative quantitative thickness values of the cornea, epithelium, flap, and residual stroma.…”

Section: Discussionmentioning

confidence: 96%

“…[1][2][3][4][5] Various causes have been suggested such as epithelial ingrowth, 1 interface inflammation, 2 steroid-induced elevation of intraocular pressure (IOP), 3 and endothelial pump dysfunction. 4,5 We present a LASIK case in which interface fluid accumulation and posterior stromal edema occurred after retinal detachment (RD) surgery.…”

mentioning

confidence: 99%

Imaging interface fluid after laser in situ keratomileusis with corneal optical coherence tomography

Wirbelauer

Pham²

2005

A 41-year-old myopic patient who had laser in situ keratomileusis 6 months earlier was treated for a complete retinal detachment (RD) with proliferative vitreoretinopathy. Surgical treatment consisted of an encircling band, pars plana vitrectomy, and silicone oil filling. Postoperatively, the patient developed marked corneal edema with no increase in intraocular pressure (IOP) as measured by applanation tonometry. Interface fluid was confirmed by corneal optical coherence tomography. Quantification of the corneal structures revealed that corneal edema was in the residual posterior stroma predominantly. The epithelial and flap thickness did not change significantly. The case demonstrated that after vitreoretinal surgery for RD repair, transient corneal endothelial cell dysfunction developed, causing marked edema of the posterior corneal stroma and interface fluid accumulation. However, an increase in IOP cannot be excluded.

“…Also in a few cases after LASIK, fluid accumulates at the flap interface, resulting in another condition similar to DLK, 2 but with a later onset, usually after the first postoperative week. [31][32][33][34][35][36][37] The ideal approach would be a prospective comparison of 2 groups of patients having LASIK using both glove brands in a double-blind study. However, as Hoffman et al 3 point out, the strong correlation between the talcfree gloves and DLK means that a controlled study would be unethical, especially considering the risks of this sightthreatening condition.…”

Section: Discussionmentioning

confidence: 99%

Surgical-glove–related diffuse lamellar keratitis after laser in situ keratomileusis

Lázaro¹,

Perea²,

Arias³

2006