Epithelial Changes And Biomechanically Corrected Iop In Diagnosing Subtle Steroid Response Post Smile

To report a post SMILE case presenting with subtle steroid response, and associated epithelial thickness and biomechanically corrected IOP (b-IOP) changes.

Nethradhama Superspeciality eye hospital, Bangalore, INDIA

A 26 year old male presented with blurriness in both eyes after an uneventful SMILE procedure 5 weeks post-operatively. His uncorrected distant visual acuity dropped to 20/40 OD and 20/60 OS, which improved to 20/30 OU with a subjective acceptance of -0.75 DS OD and -0.75/-0.75 @ 140 OS. Non Contact Tonometer values of IOP were 18 and 20 mmHg, while the b-IOP measured 22 and 23 mmHg in OD and OS respectively. AS-OCT revealed minimal interface fluid with epithelial thickening (OS>OD).  Topical steroids were discontinued and antiglaucoma medications were prescribed. One week later, the b-IOP decreased to 17 mm Hg OU, interface fluid and epithelial changes resolved, and UDVA recovered fully.

Epithelial thickness and b-IOP may be sensitive indicators to diagnose subtle steroid response post SMILE.