Pressure-Induced Interlamellar Stromal Keratitis After Small-Incision Lenticule Extraction Procedure: A Case Report

Abstract

Purpose: To report a case of pressure-induced interlamellar stromal keratitis (PISK) after small-incision lenticule extraction (SMILE) for the correction of myopic astigmatism in the United States. Methods: We report the case of a 27-year-old man who underwent uneventful SMILE surgery and presented with pressure-induced stromal keratitis. Anterior and posterior segment examination, uncorrected distance visual acuity, refraction, intraocular pressure, and pachymetry values are reported from this time period. Results: Three weeks postoperatively, examination revealed new-onset central corneal haze and edema in both eyes, more significant in the right eye. The patient was given a presumptive diagnosis of diffuse lamellar keratitis. Intensive corticosteroid treatment was administered, causing a significant decline in uncorrected distance visual acuity OD from 20/25 to 20/250 and OS from 20/20 to 20/60, with a significant myopic shift of −3.0 D and −1.0 D, respectively. In our case, pachymetry measurements revealed 78 μm OD and 43 μm OS of additional corneal thickness. Pressure readings were 25 mm Hg OD and 19 mm Hg OS, respectively. He was diagnosed with PISK, and after 4 days of steroid discontinuation and Brimonidine-Timolol administration, his symptoms had improved with resolution of corneal edema. Conclusions: Clinicians should be aware that PISK is a potential complication of SMILE. Postoperative intraocular pressure measurements are an important aspect of the management of postcorneal refractive surgery patients because the differentiation of PISK from diffuse lamellar keratitis, as well as the early detection and treatment of PISK, can avoid severe complications.

Comparison of Vision Correction and Corneal Thickness at 180-Day Follow-Up After Femtosecond Laser-Assisted In-Situ Keratomileusis (FS-LASIK), Photorefractive Keratectomy (PRK), and Small Incision Lenticule Extraction (SMILE): A Study from a Single Center in Poland of 120 Patients with Myopia

“…The SMILE method was approved by the US FDA in 2016 for the treatment of myopia from −1 D to −8 D and astigmatism in the range of −0.5 D in patients over 22 years of age [ 21 ]; however, in 2018, the indications for SMILE were extended to include myopic astigmatism up to 3 D [ 21 ].…”

“…SMILE is a better choice than LASIK for patients who play contact sports and have mild dry eyes in the preoperative period. In addition, higher-order aberrations are less common with SMILE, which is especially common in people with large pupils [ 21 ]. Nevertheless, SMILE is a more complicated procedure than LASIK, which may affect the frequency of performing the LASIK by novice refractive surgeons [ 21 ].…”

“…The effectiveness of the LVC method is defined as the ratio of postoperative uncorrected distance visual acuity (UDVA) to preoperative corrected distance visual acuity (CDVA) [ 24 ]. Patients should have a stable refraction within ±0.5 D for at least 1 year before undergoing SMILE [ 21 ]. SMILE is not recommended for patients with known corneal thinning disorders, such as keratoconus or a central corneal thickness (CCT) less than 475 micrometers, poorly controlled glaucoma, uveitis, cataracts, corneal scarring, functional monocularity, active ocular inflammation or infection, or severe dry eye or ocular allergy [ 21 ].…”

Comparison of triple-DMEK to pseudophakic-DMEK: A cohort study of 95 eyes

“…The disease is age-related, mostly manifesting after the fourth decade [ 23 ]. Due to this, patients with FECD often present with other age-related ocular comorbidities, including cataract [ 26 ], whose prevalence in Europeans increases from 5% in 52–62-year-olds to 64% in >70-year-olds [ 27 ]. Consequently, the advent of DMEK for FECD quickly triggered a debate about whether phacoemulsification and DMEK should be conducted in stages or in the same operation (known as phaco-DMEK or triple-DMEK).…”

Evaluate the Prevalence, Natural Course, and Final Visual Acuity in Patients with Stages III or IV of Diffuse Lamellar Keratitis Following Laser in Situ Keratomileusis

“…Treatment with corticosteroids before and after surgery reduces the severity of DLK 6,7 , but treatment with fabric membrane stabilizers and nonsteroidal anti-inflammatory drugs have less effect on the DLK process after surgery 8 . Increased intraocular pressure (IOP) following surgery can create a clinical picture similar to DLK (false DLK) 9 . Therefore, IOP control is necessary in patients with suspected DLK 10 .…”