Want to take quizzes and track your credits?
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.
Please finish quiz first before checking answer.
Read the answer below and download your certificate.
Read the discussion below and retake the quiz.
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.
Sign in to take quiz and track your certificates
JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC
Corresponding Author: Milica A. Margeta, MD, PhD, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles St, Boston, MA 02114 (firstname.lastname@example.org).
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.
You currently have no searches saved.