Interface Fluid Syndrome Induced by Uncontrolled Intraocular Pressure Without Triggering Factors After LASIK in a Glaucoma Patient

Abstract

This study sought to describe a glaucoma patient with interface fluid syndrome (IFS) induced by uncontrolled intraocular pressure (IOP) without triggering factors after laser in situ keratomileusis (LASIK).Case report and review of the literature.A 23-year-old man with open-angle glaucoma underwent bilateral LASIK for myopia in 2009. Two years later, the patient reported sudden vision loss. The IOP in the right eye was not measurable using Goldmann applanation tonometry (GAT), but was determined to be 33.7 mm Hg using a noncontact tonometer. IFS was diagnosed based on the presence of space-occupying interface fluid on anterior segment optical coherence tomography images. After a trabeculectomy was performed, the IOP decreased to 10 mm Hg, and GAT measurement became possible. However, the corneal fold remained visible in the flap interface. Six months later, the IOP in the left eye increased, and a trabeculectomy was performed during the early stages of this increase in IOP. Following this procedure, the IOP decreased, and visual acuity remained stable.In glaucoma cases that involve a prior increase in IOP, IOP can continue to increase during the disease course even if temporary control of IOP has been achieved. If LASIK is performed in such cases, the treatment of glaucoma becomes insufficient because of underestimation of the typical IOP. In fact, the measurement of IOP can become difficult because of high-IOP levels. Therefore, LASIK should not be performed on patients with glaucoma who are at high risk of elevated IOP.

Elevated Intraocular Pressure in a Young Man With a History of Laser-Assisted In Situ Keratomileusis

“…1,2,[6][7][8][9] Because of this factor, the primary therapeutic goal for these patients should be to decrease IOP through the initiation of ocular hypotensive agents and the rapid discontinuation of steroids. However, there are case reports documenting IFS in contexts other than postoperative steroid use, including in a patient who developed IFS after spontaneous IOP increase years after undergoing LASIK, 10 similar to the present patient.…”

Determinants of visual quality after endothelial keratoplasty

“…While laser in situ keratomileusis (LASIK) involves a stroma-stroma interface, visual outcomes of millions of patients worldwide have been excellent -excluding complicated cases involving infection, 61 uveitis, 78 interface haemorrhage, 128 interface edema, 83,117 or clinically obvious opacity. 38 This suggests that a stroma-stroma interface per se does not impair vision.…”

Interface Fluid Syndrome Following LASIK Surgery - A Retrospective Pooled Analysis and Systematic Review of the Literature.

“…8,9 This is of concern because patients are frequently prescribed topical steroids after LASIK and other ophthalmic procedures. [10][11][12] These steroid-responsive patients are at risk of elevated IOP that drives fluid accumulation at the corneal interface, leading to IFS development. If IFS is not quickly identified along with steroid cessation, high IOP can lead to optic nerve damage, glaucomatous optic neuropathy, and rapid vision loss.…”

“…If IFS is not quickly identified along with steroid cessation, high IOP can lead to optic nerve damage, glaucomatous optic neuropathy, and rapid vision loss. 7,8,10 It is important to note that IFS has also been linked to other causes, including endothelial cell dysfunction, as seen in conditions like Fuchs dystrophy, endothelial cell insufficiency, and uveitis. 1,4,8,[13][14][15] Diagnosing IFS can be challenging because of its rare prevalence and common features with other conditions such as infectious keratitis or diffuse lamellar keratitis (DLK), which also present with diffuse corneal haze.…”

“…If IFS is not quickly identified along with steroid cessation, high IOP can lead to optic nerve damage, glaucomatous optic neuropathy, and rapid vision loss. 7,8,10 It is important to note that IFS has also been linked to other causes, including endothelial cell dysfunction, as seen in conditions like Fuchs dystrophy, endothelial cell insufficiency, and uveitis. 1,4,8,13–15…”