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Pressure-Induced Stromal Keratopathy after Surface Ablation Surgery.
Jaime Guedes1, Rodrigo Vilares-Morgado1,2, Rodrigo Brazuna1,3
1Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil.
Case Reports in Ophthalmology
|July 17, 2024
Summary
This report details a rare case of pressure-induced stromal keratopathy after photorefractive keratectomy, complicated by herpetic keratitis. Treatment improved intraocular pressure and corneal biomechanics.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Ocular Imaging
Background:
- Pressure-induced stromal keratopathy (PISK) is a rare complication following refractive surgery.
- Herpetic keratitis can present with similar stromal opacities, complicating diagnosis.
Observation:
- A 33-year-old male presented with delayed corneal healing post-photorefractive keratectomy (PRK).
- Slit lamp and Scheimpflug imaging revealed stromal opacity and a hyperreflective area.
- Elevated intraocular pressure (IOP) was noted, with significant discrepancy between Goldmann and Corvis ST measurements.
Findings:
- Corneal tomography and biomechanical assessment were performed using Pentacam and Corvis ST.
- Treatment with oral valacyclovir and hypotensive therapy resolved PISK and improved corneal parameters.
- Goldmann applanation tonometry showed inaccuracy in measuring IOP in this PISK case.
Implications:
- Surgeons must consider PISK in cases of delayed healing or stromal opacity post-PRK.
- Accurate IOP measurement is crucial, as Goldmann tonometry may be unreliable in PISK.
- Combined antiviral and hypotensive therapy can effectively manage PISK associated with herpetic keratitis.
