Delayed-onset pressure-induced interlamellar stromal keratitis (PISK) and interface epithelial ingrowth 10 years after laser-assisted in situ keratomileusis

Abstract

Purpose: To report a case of pressure-induced interlamellar stromal keratitis (PISK) 10 years after laser assisted in situ keratomileusis (LASIK).

Observations: A case of a 36-year-old man who underwent LASIK and presented with PISK 10 years later. Before presenting to our department he consulted elsewhere for red eye, decreased visual acuity, foreign body sensation, and pain on the RE for 1 week. He was then prescribed topical prednisolone six times per day and was lost to follow-up. On examination and after 1 month of continuous use of steroids uncorrected distance visual acuity (UCDV) was 20/400 in the right eye (RE) and 20/20 in the left eye (LE). Best corrected visual acuity was 20/80 on the RE. The Goldmann intraocular pressure (IOP) was 26 and 17 mmHg in the RE and LE, respectively. Slit lamp biomicroscopy revealed fluid in the interface and epithelial ingrowth. Fundoscopic examination results were normal in both eyes. Treatment was initiated with topical brimonidine tartrate 0.2%, timolol 0.5%, and dorzolamide 2.0% BID. Once the pressure was controlled the patient was scheduled for mechanical debridement of the epithelial ingrowth with significant improvement of UCVA (20/25).

Conclusions: Refractive surgeons should be aware of PISK as a potential complication of LASIK even years after the procedure. Intraocular pressure can be misleading, and diligent and careful examination are key to diagnosis and treatment of this potentially blinding complication.

Keywords: Diffuse lamellar keratitis; Interface fluid syndrome steroid-induced ocular hypertension; Laser-assisted in situ keratomileusis; Pressure-induced interlamellar stromal keratitis.

Fig. 1

A) Curvature sagittal map showing irregular astigmatism in the same area as the intraepithelial ingrowth. B) Corneal thickness map reporting a central pachymetry of 579 μm. C) Optical coherence tomography of the Right Eye showing the fluid accumulated between the flap and the stromal bed.

Fig. 2

A) General illumination slit-lamp image showing intraepithelial growth around pupil margin (arrow). B) Diffuse illumination showing epithelial ingrowth and irregular flap border (arrow). C) Anterior segment OCT showing interface fluid (green arrows) and intraepithelial ingrowth (yellow arrow). D) 1 week after procedure showing general illumination without epithelial ingrowth. E) Diffuse illumination 1 week after procedure with residual edema (arrow) and without epithelial ingrowth. F) 1 week after procedure AS-OCT without fluid or epithelial ingrowth. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)