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

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A 24-year-old South Asian man presented with acute-onset pain and decreased vision in his left eye. His ocular history was significant for high myopia, a long-standing traumatic retinal detachment in his right eye, and laser-assisted in situ keratomileusis (LASIK) surgery of the left eye 8 months earlier. Three months earlier, the patient experienced an episode of elevated intraocular pressure (IOP) of the left eye, which was treated with travoprost ophthalmic solution, 0.004%, and oral acetazolamide and resolved. The patient’s presenting visual acuity was counting fingers OD (baseline) and 20/200 OS. His initial IOPs were right eye 16 mm Hg and left eye 46 mm Hg by TonoPen. Examination of the left eye indicated normal gonioscopy results and unremarkable anterior and posterior segment examination findings except for the presence of corneal edema without keratic precipitates. The patient started treatment with dorzolamide hydrochloride, timolol maleate, brimonidine tartrate, latanoprost, and oral acetazolamide.

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Interface fluid syndrome

B. Recheck IOP with a handheld tonometer off the LASIK flap

After the low GAT-determined pressure, the patient’s IOP was rechecked with a TonoPen and was found to be 36 mm Hg (choice B). Anterior segment optical coherence tomography revealed a pocket of intrastromal fluid (Figure 2), consistent with interface fluid syndrome (IFS). Given the highly elevated IOP, reassuring the patient and rechecking IOP in 1 week (choice D) would not be appropriate. Increasing the frequency of prednisolone administration (choice A) would not be recommended because it may contribute to a steroid response and exacerbate IFS. Injecting foscarnet intravitreally (choice C) is not indicated given no evidence of posterior pole involvement.

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Article Information

Corresponding Author: Milica A. Margeta, MD, PhD, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles St, Boston, MA 02114 (milica_margeta@meei.harvard.edu).

Published Online: January 3, 2019. doi:10.1001/jamaophthalmol.2018.5430

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
1.
Lyle  WA, Jin  GJ.  Interface fluid associated with diffuse lamellar keratitis and epithelial ingrowth after laser in situ keratomileusis.  J Cataract Refract Surg. 1999;25(7):1009-1012. doi:10.1016/S0886-3350(99)00083-8PubMedGoogle ScholarCrossref
2.
Belin  MW, Hannush  SB, Yau  C-W, Schultze  RL.  Elevated intraocular pressure–induced interlamellar stromal keratitis.  Ophthalmology. 2002;109(10):1929-1933. doi:10.1016/S0161-6420(02)01163-6PubMedGoogle ScholarCrossref
3.
Lee  V, Sulewski  ME, Zaidi  A, Nichols  CW, Bunya  VY.  Elevated intraocular pressure-induced interlamellar stromal keratitis occurring 9 years after laser in situ keratomileusis.  Cornea. 2012;31(1):87-89. doi:10.1097/ICO.0b013e31821140faPubMedGoogle ScholarCrossref
4.
Najman-Vainer  J, Smith  RJ, Maloney  RK.  Interface fluid after LASIK: misleading tonometry can lead to end-stage glaucoma.  J Cataract Refract Surg. 2000;26(4):471-472. doi:10.1016/S0886-3350(00)00382-5PubMedGoogle ScholarCrossref
5.
Hamilton  DR, Manche  EE, Rich  LF, Maloney  RK.  Steroid-induced glaucoma after laser in situ keratomileusis associated with interface fluid.  Ophthalmology. 2002;109(4):659-665. doi:10.1016/S0161-6420(01)01023-5PubMedGoogle ScholarCrossref
6.
Dawson  DG, Schmack  I, Holley  GP, Waring  GO  III, Grossniklaus  HE, Edelhauser  HF.  Interface fluid syndrome in human eye bank corneas after LASIK: causes and pathogenesis.  Ophthalmology. 2007;114(10):1848-1859. doi:10.1016/j.ophtha.2007.01.029PubMedGoogle ScholarCrossref
7.
Tourtas  T, Kopsachilis  N, Meiller  R, Kruse  FE, Cursiefen  C.  Pressure-induced interlamellar stromal keratitis after laser in situ keratomileusis.  Cornea. 2011;30(8):920-923. doi:10.1097/ICO.0b013e3182032002PubMedGoogle Scholar
8.
Rehany  U, Bersudsky  V, Rumelt  S.  Paradoxical hypotony after laser in situ keratomileusis.  J Cataract Refract Surg. 2000;26(12):1823-1826. doi:10.1016/S0886-3350(00)00763-XPubMedGoogle ScholarCrossref
9.
Davidson  RS, Brandt  JD, Mannis  MJ.  Intraocular pressure-induced interlamellar keratitis after LASIK surgery.  J Glaucoma. 2003;12(1):23-26. doi:10.1097/00061198-200302000-00004PubMedGoogle ScholarCrossref
10.
Shoji  N, Ishida  A, Haruki  T, Matsumura  K, Kasahara  M, Shimizu  K.  Interface fluid syndrome induced by uncontrolled intraocular pressure without triggering factors after LASIK in a glaucoma patient: a case report.  Medicine (Baltimore). 2015;94(39):e1609. doi:10.1097/MD.0000000000001609PubMedGoogle ScholarCrossref
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