Elevated intraocular pressure-induced interlamellar stromal keratitis

Abstract

Purpose: To describe a series of cases (Elevated Intraocular Pressure Induced Interlamellar Stromal Keratitis (PISK)) that appears to be identical to post-laser in situ keratomileusis (LASIK) diffuse lamellar keratitis (DLK), but was present at a later time frame and was associated with a significant elevation of intraocular pressure (IOP). Unlike DLK, this syndrome is not steroid responsive, but resolves with a lowering of the IOP.

Design: Retrospective, noncomparative, small case series.

Participants: The medical records of four LASIK patients with IOP-induced interface changes for the 1-year period March 2000 to March 2001 were reviewed retrospectively.

Main outcome measure: Slit-lamp appearance.

Results: In the four cases presented, the slit-lamp findings and visual degradation appeared identical to DLK. All cases, however, presented outside of the first postoperative week and were not associated with any antecedent trauma. All four cases failed to respond to high-dose topical steroids. Significant IOP elevations were noted in all cases, and the interface changes responded dramatically to both a lowering of the IOP and a discontinuation or lowering of the topical steroids.

Conclusions: Elevated IOP-induced post-LASIK interface keratitis (PISK) is a poorly documented phenomena. Because the condition may be caused by or worsened by frequent topical steroids, early recognition is important. Treatment consists primarily of normalizing the IOP.