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Abstract #6772 Published in IGR 4-1
Steroid-induced glaucoma after laser in situ keratomileusis associated with interface fluid
Hamilton DR; Manche E; Rich LF; Maloney RKOphthalmology 2002; 109: 659-665
PURPOSE: To report the ocular manifestations and clinical course of eyes developing interface fluid after laser in situ keratomileusis (LASIK) surgery from a steroid-induced rise in intraocular pressure (IOP). DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS/INTERVENTION: The authors examined six eyes of four patients who had diffuse lamellar keratitis develop after uneventful myopic LASIK surgery and were treated with topical corticosteroids. PRINCIPAL OUTCOME MEASURE: Slit-lamp findings, IOP measurements, and visual field loss. RESULTS: All eyes had a pocket of fluid develop in the lamellar interface between the flap and the stromal bed associated with a corticosteroid-induced rise in IOP. However, because of the interface fluid, IOP was normal or low by central corneal Goldmann applanation tonometry in all eyes. The elevated IOP was diagnosed by peripheral measurement in several cases after months of elevated pressure. All six eyes had visual field defects develop. Three eyes of two patients had severe glaucomatous optic neuropathy and decreased visual acuity develop as a result of undiagnosed steroid-induced elevated IOP. CONCLUSIONS: A steroid-induced rise in IOP after LASIK can cause transudation of aqueous fluid across the endothelium that collects in the flap interface. The interface fluid leads to inaccurately low central applanation tonometry measurements that obscure the diagnosis of steroid-induced glaucoma. Serious visual loss may result.
Dr. D.R. Hamilton, Jules Stein Eye Institute, University of California-Los Angeles, Los Angeles, CA 90095, USA
Classification:
9.4.1 Steroid-induced glaucoma (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
9.4.2 Glaucomas associated with disorders of the cornea, conjunctiva, sclera (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
