Pressure-induced interface keratitis: A late complication following LASIK

PISK appears clinically almost identical to diffuse lamellar keratitis after LASIK. It is important to measure the IOP and be suspicious when a diffuse interface haze occurs after the first postoperative week, is resistant to or even exacerbates in response to an increase in topical steroid treatment, and is not associated with other causative events. Slit-lamp optical coherence tomography is a valuable tool that allows differentiation between space-occupying interface fluid collection and non-space-occupying interface fluid collection to avoid falsely low or normal IOP measurements in PISK.

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Delayed onset of pressure-induced interlamellar stromal keratitis in a patient with recurrent uveitis

Kuo

Chang

Chou

et al. 2017

Medicine

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Introduction:Corticosteroid treatment for uveitis can lead to delayed-onset pressure-induced interlamellar stromal keratitis (PISK), even years after laser in situ keratomileusis (LASIK).A 35-year-old man presented to our clinic after experiencing blurred vision in his left eye for 1 month. For the past month, he had been prescribed topical steroid and anti-glaucomatous medication. He had undergone LASIK for both eyes 5 years earlier, and had suffered uveitis attacks in his left eye over the last 2 years.Slit-lamp examination revealed stromal haziness with interface fluid accumulation in the left eye. The left eye showed an intraocular pressure (IOP) of 35 mm Hg and visual acuity of 6/20. Anterior segment ocular coherence tomography (OCT) confirmed the diagnosis of PISK. Steroid treatment was tapered, and latanoprost treatment was started. One month later, the patient's symptoms resolved, with IOP reduced to 10 mm Hg and visual acuity increased to 6/6 in the left eye. Latanoprost treatment was discontinued to avoid potential uveitis reactivation, and the patient's visual field defect progressed and IOP rebounded. Due to evident glaucomatous damage, trabeculectomy was suggested but was refused.Conclusion:Patients with PISK plus uveitis should be treated with a tailored regimen involving corticosteroid and antiglaucomatous medication or surgical intervention based on the individual condition. Early recognition and appropriate treatment may aid in preventing severe visual sequela in such patients.

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Pressure-induced interface keratitis: A late complication following LASIK

Cited by 3 publications

References 32 publications

Cirugía refractiva corneal y biomecánica

Cirugía refractiva corneal y biomecánica

Pressure-Induced Interlamellar Stromal Keratitis After Laser In Situ Keratomileusis

Delayed onset of pressure-induced interlamellar stromal keratitis in a patient with recurrent uveitis

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