ESCRS - PP15.17 - Late Onset Of Pressure-Induced Stromal Keratopathy

Late Onset Of Pressure-Induced Stromal Keratopathy

Published 2024 - 42nd Congress of the ESCRS

Reference: PP15.17 | Type: Free paper | DOI: 10.82333/gd0k-zt36

Authors: Luis Álvarez-Cascos-López* 1 , Blanca Benito-Pascual 1 , Laura Gil-Amado 1 , Santiago López-García 1

1Severo Ochoa University Hospital,Leganés,Spain

Purpose

To describe the entity known as pressure-induced stromal keratopathy (PISK) based on a case of late presentation with the main risk factors for its development.

Setting

Secondary public hospital in Madrid, Spain

Methods

A 46-year-old woman who underwent laser in situ keratomileusis (LASIK) 9 years ago and glaucoma surgery 5 years later, presented to the emergency department with microbial keratitis in the right eye. After treatment and subsequent healing of the epithelial defect, corticosteroids were administrated to reduce corneal opacity, but improvement was not achieved. She then underwent anterior segment optical coherence tomography (AS-OCT) observing fluid between the corneal stroma and the LASIK flap. Following that, peripherally intraocular pressure (IOP) was measured by rebound tonometry, with values ranging from 25 to 38 mmHg. Afterwards, the patient started topic hypotensive treatment in addition to discontinuation of topical corticosteroids.

Results

After 6 months, peripheral IOP was 19 mmHg, but haze, fluid at the stroma-flap interface measured by AS-OCT, and the same visual acuity persisted.

Conclusions

PISK is a challenging-to-diagnose condition characterized by fluid accumulation beneath the LASIK flap. Its pathophysiology is not entirely clear, but most cases are described by an increase in intraocular pressure (IOP) secondary to the initiation of topical corticosteroid therapy.