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Diagnosis of pressure-induced stromal keratitis (PISK) after laser in situ keratomileusis (LASIK) by performing optical coherence tomography (OCT) and slit-lamp (SL): a case report

Poster Details

First Author: O.Guergué Díaz de Cerio SPAIN

Co Author(s):    S. Lopez-Plandolit Antolin   P. Fernandez Avellaneda                 

Abstract Details

Purpose:

A case to report an unusual complication after LASIK.

Setting:

Ophthalmology and Eye Surgery Service of Basurto University Hospital and Instituto Clinico Quirurgico Oftalmologico; Bilbao, Spain.

Methods:

An otherwise healthy 51-year-old male, had hyperopic LASIK surgery with overcorrection of left eye (OS) for monovision. A week after a non- complicated surgery, the patient suffered a bilateral visual acuity (VA) loss: Best Corrected Visual Acuity (BCVA) in right eye (OD) 60/200 and OS: 20/200. Intraocular pressure (IOP) was normal. The diagnosis of DLK (Diffuse Lamellar Keratitis) was made and he was therefore treated with an intensified corticosteroid regime. Three days after, the BCVA and corneal edema remained the same; and the IOP was increased: 50 OD / 56 OS mmHg. Thus the correct diagnosis of PISK was made.

Results:

After the corticosteroids were quit a complete clinical resolution in just two days was observed: spontaneous VA 1,0 in OD /1,0 with -1,00 OS and normalization of the IOP. SL and anterior segment - OCT images before and after resolution are provided.

Conclusions:

PISK is caused by an intraocular pressure increase in postLasik patients after steroid treatment. This condition is clinically indistinguishable from DLK, which is a more common complication and requires corticosteroid treatment. The IOP determination is essential for the differential diagnosis of both entities. However, as IOP measurements may be underestimated in these patients, PISK should always be suspected in the absence of resolution and /or worsening of the disease with increased dose of corticosteroids.

Financial Disclosure:

NONE

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