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ABSTRACT
PURPOSE: To report ocular manifestations of eyes that developed interface fluid syndrome secondary to steroid-induced elevation of intraocular pressure (IOP) after LASIK. The patients presented with similiar characteristics of diffuse lamellar keratitis (DLK).
METHODS: Retrospective evaluation of four eyes of three patients with loss of vision, fluid in the lamellar interface, and IOP and topographic changes due to prolonged treatment with topical corticosteroids after LASIK.
RESULTS: Slit-lamp microscopy revealed an optically clear fluidfilled space between the flap and stromal bed. After early diagnosis, treatment with topical corticosteroids was stopped, resulting in quick and progressive cessation of symptoms.
CONCLUSIONS: A steroid-induced rise in IOP after LASIK can cause transudation of aqueous fluid across the endothelium that collects in the flap interface. It is important to make an early differential diagnosis of interface fluid syndrome in DLK-suspected cases, as continued treatment with corticosteroids can produce serious visual loss. [J Refract Surg. 2009;25:235-239.]
Laser in situ keratomileusis (LASIK) is the most common refractive surgery procedure to correct moderate to severe myopia.1 Postoperative topical corticosteroids are typically prescribed to treat inflammatory processes in patients who undergo LASIK. However, it is reported that 5% to 7% of the general population responds to corticosteroids with significant increases in intraocular pressure (IOP).2
Fluid collection in the interface, termed interface fluid syndrome, is an unusual complication after LASIK. It is reported to result from increased IOP, decreased endothelial cell density, or uveitis.3 We emphasize the importance of early diagnosis and treatment to avoid damage to the optic nerve.
CASE REPORTS
Four eyes of three patients with a similar evolution after LASIK surgery with administration of corticosteroids are reported. Patients underwent uneventful LASIK in both eyes using the Keracor 217 excimer laser (Bausch & Lomb GmbH, Feldkirchen, Germany) and the Moria One microkeratome (Moria, Antony, France) to create the flaps. Tobramycin 1 mg and dexamethasone 3 mg collyrium (TobraDex; Alcon Cusí S.A., Barcelona, Spain) four times a day for 1 week and artificial tears (Oculotect; Novartis Farmacéutica S.A., Barcelona, Spain) as needed were prescribed postoperatively. All patients presented 3 weeks after surgery with decreased visual acuity, keratometric and topographic changes, and fluid in the interface (Table 1).
CASE 1
A 34-year-old man presented 3 weeks after LASIK with decreased uncorrected visual...