Bilateral interface fluid syndrome and glaucoma progression after laser-assisted in situ keratomileusis

Abstract

A 32-year-old male with a past history of bilateral laser-assisted in situ keratomileusis (LASIK), presented with a decrease in vision in both eyes (BE). Clinical examination showed diffuse corneal haze and interface fluid syndrome (IFS), which was confirmed on anterior segment optical coherence tomography. Intraocular pressure (IOP) measurements obtained with Goldmann applanation tonometer (GAT) were low; however, digital tonometry indicated a raised IOP in BE, which was confirmed by measuring IOP with GAT, outside the peripheral edge of the LASIK flap. Treatment with antiglaucoma medications resulted in complete resolution of the interface fluid. However, due to noncompliance with medications, it recurred and glaucoma showed progression. The patient underwent trabeculectomy with mitomycin C in BE, resulting in improvement in the visual acuity, clear cornea, resolution of interface fluid, and normal IOP, till the last follow-up visit. This case had IFS secondary to episodes of raised IOP, which was diagnosed on careful clinical examination. IOP readings using GAT over the central cornea can give spuriously low readings in IFS. Hence, IOP should be measured in the peripheral cornea to obtain correct IOP readings. Early detection of high IOP and its management is essential to halt glaucoma progression.

Keywords: Glaucoma; Goldmann applanation tonometry; interface fluid syndrome; intraocular pressure; laser-assisted in situ keratomileusis.

Figure 1

(a-d) Slit-lamp photograph at presentation shows an edematous cornea in the RE (a) and LE (c). Slit section of the cornea showing interface fluid (yellow arrow) in RE (c) and LE (d). RE: Right eye, LE: Left eye

Figure 2

(a and b) Anterior segment optical coherence tomography shows a cleft-like hyporeflective area within the anterior stroma, corresponding to the interface fluid accumulation under the LASIK flap and its thickness in microns in RE (a) and LE (b). RE: Right eye, LE: Left eye

Figure 3

(a-d) Slit view of the cornea a day after trabeculectomy, shows a clear cornea, resolved interface fluid with well-apposed flaps in RE (a) and LE (c). At the last follow-up visit, diffuse slit lamp examination clear cornea and good bleb in RE (b) and LE (d). RE: Right eye, LE: Left eye

Figure 4

(a and b) Anterior segment OCT showing a reduction in the corneal thickness, no interface fluid, and well-apposed flaps in the RE (a) and LE (b). OCT: Optical coherence tomography RE: Right eye, LE: Left eye