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[SILK--Steroid-induced lamellar keratopathy. A case report]
1Augenklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel. mamm@ophthalmol.uni-kiel.de.
Case Report:
After uneventful myopic LASIK, both interfaces of a 31-year-old, healthy male patient showed 5 days (right eye) and 7 days (left eye) postoperatively a diffuse, multifocal infiltration confined to the flap interface which was interpreted as a diffuse lamellar keratitis, stage 2-3. The routine postoperative treatment with local antibiotics and steroids was intensified to local steroids hourly. At that time intraocular pressure (IOP) was 19 mmHg (right) and 18 mmHg (left) (centrally measured by Goldmann applanation tonometry). Following 2 weeks under this therapy the keratitis did not resolve and IOP increased up to 30 mmHg. Local and systemic antiglaucomatosa were administered and IOP was reduced to 22 and 24 mmHg, respectively. Corneal interface infiltration, however, remained unchanged. Only the complete stop of the local corticosteroids induced a rapid regression and corneal transparency returned. IOP was normalized down to 10 mmHg without additional therapy.
Discussion:
1) It is essential to measure IOP in the early postoperative phase after LASIK, especially in cases of corneal haze. 2) After corneal refractive surgery with high corneal ablation, IOP data in the upper range has to be interpreted as pathological. 3) Steroid-induced lamellar keratopathy is postulated as being a separate entity. 4) In cases of stromal infiltration after LASIK and increased IOP, local steroids have to be reduced immediately.
Insights
Intraocular pressure (IOP) can increase after laser-assisted in situ keratomileusis (LASIK) due to steroid use for diffuse lamellar keratitis. Reducing steroids quickly resolves this issue and normalizes IOP.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Pharmacology
Background:
- Laser-assisted in situ keratomileusis (LASIK) is a common refractive surgery.
- Diffuse lamellar keratitis (DLK) is a potential postoperative complication.
- Steroid eye drops are routinely used post-LASIK to manage inflammation.
Observation:
- A patient developed stage 2-3 DLK post-LASIK.
- Intensified topical steroid treatment led to elevated intraocular pressure (IOP) and persistent corneal infiltrates.
- Standard glaucoma treatments were insufficient to control IOP while steroids continued.
Findings:
- Complete cessation of topical corticosteroids resulted in rapid DLK resolution and corneal transparency.
- IOP normalized without additional glaucoma medication after stopping steroids.
- The case suggests a link between topical steroid use, DLK, and steroid-induced ocular hypertension.
Implications:
- Monitoring IOP is crucial in the early post-LASIK period, especially with corneal haze.
- Elevated IOP post-refractive surgery, particularly after high ablation, should be considered pathological.
- Immediate reduction of topical steroids is recommended for stromal infiltrates and elevated IOP after LASIK.
