Interface fluid syndrome: A potential lifelong complication after LASIK. A case report

Purpose

To describe a case of interface fluid formation caused by uncontrollable intraocular pressure (IOP) 16 years after laser-assisted in situ keratomileusis (LASIK) surgery secondary to Posner Schlossman Syndrome (PSS).

Observations

After trabeculectomy operation, IOP of the operative eye was back to normal, and the interface fluid refluxed over time.

Conclusions

and importance: Interface Fluid Syndrome can be a potential lifelong complication after LASIK surgery. PSS patients post-LASIK require early IOP control.

The Effect of Corneal Refractive Surgery on Glaucoma

Laser-assisted refractive procedures have become very popular in the last two decades. As a result, a "generation" of patients with altered corneal properties is emerging. These patients will require both cataract extraction and glaucoma follow-up in the future. Since the glaucoma examination largely depends on the corneal properties, the reshaped postrefractive surgery cornea poses a challenge in the diagnosis, follow-up, and management of the glaucomatous patient. In order to overcome this problem, every patient who is planned to undergo corneal refractive surgery must have a thorough glaucoma examination in order for the ophthalmologist to be able to monitor their patients for possible glaucoma development and/or progression. Some examinations such as tonometry are largely affected by the corneal properties, while others such as the evaluation of the structures of the posterior pole remain unaffected. However, the new imaging modalities of the anterior segment in combination with the most recent advances in tonometry can accurately assess the risk for glaucoma and the need for treatment.

In vivo confocal microscopic observations of eyes diagnosed with posterior corneal vesicles

PURPOSE

To determine the morphological characteristics of the cornea in eyes with posterior corneal vesicles (PCV) determined by in vivo confocal microscopy (IVCM). In addition, to compare the morphological characteristics of the corneas of eyes with PCV to those of eyes with posterior polymorphous corneal dystrophy (PPCD).

METHODS

Three males and three females aged 17-75 years who were diagnosed with PCV by slit-lamp biomicroscopic findings were studied. The slit-lamp findings, specular microscopic images, corneal endothelial cell densities (CDs), central corneal thickness, and IVCM images were evaluated. Three cases that had been diagnosed with PPCD were also evaluated, and the findings were compared to those in eyes with PCV.

RESULTS

All six cases of PCV had unilateral lesions of Descemet's membrane and the corneal endothelium. Slit-lamp biomicroscopy showed broad, band-shaped lesions in five cases and multiple vesicle lesions in one case of PCV. The IVCM images of the six cases had a common appearance of the corneal endothelial cells in the affected areas showing iso-reflective nuclei and low reflective cell membranes as seen in normal corneal endothelial cells. The CDs in the affected eyes were about one-half of those of the not affected eyes. The IVCM images of the corneas of patients with PPCD showed polymorphic cells with hyperreflective nuclei, which are characteristics of epithelial cells.

CONCLUSIONS

The IVCM images demonstrated that the corneal endothelial cells of patients with PCV have normal morphology. These findings indicate that PCV is a distinct clinical entity different from PPCD.

Interface Fluid Syndrome Induced by Uncontrolled Intraocular Pressure Without Triggering Factors After LASIK in a Glaucoma Patient: A Case Report

This study sought to describe a glaucoma patient with interface fluid syndrome (IFS) induced by uncontrolled intraocular pressure (IOP) without triggering factors after laser in situ keratomileusis (LASIK). Case report and review of the literature. A 23-year-old man with open-angle glaucoma underwent bilateral LASIK for myopia in 2009. Two years later, the patient reported sudden vision loss. The IOP in the right eye was not measurable using Goldmann applanation tonometry (GAT), but was determined to be 33.7 mm Hg using a noncontact tonometer. IFS was diagnosed based on the presence of space-occupying interface fluid on anterior segment optical coherence tomography images. After a trabeculectomy was performed, the IOP decreased to 10 mm Hg, and GAT measurement became possible. However, the corneal fold remained visible in the flap interface. Six months later, the IOP in the left eye increased, and a trabeculectomy was performed during the early stages of this increase in IOP. Following this procedure, the IOP decreased, and visual acuity remained stable. In glaucoma cases that involve a prior increase in IOP, IOP can continue to increase during the disease course even if temporary control of IOP has been achieved. If LASIK is performed in such cases, the treatment of glaucoma becomes insufficient because of underestimation of the typical IOP. In fact, the measurement of IOP can become difficult because of high-IOP levels. Therefore, LASIK should not be performed on patients with glaucoma who are at high risk of elevated IOP.