Post-LASIK edema-induced keratopathy (PLEK), a new name based on pathophysiology of the condition

Abstract

A 33-year-old man who underwent uneventful laser in situ keratomileusis (LASIK) developed pressure-induced stromal edema resulting in an interface haze in both eyes and a pocket of fluid under the flap of the right eye 10 days after surgery, while receiving topical fluorometholone. Intraocular pressure by applanation tonometry was 16 mm Hg in his right eye (erroneous result due to the fluid in the interface) and 34 mm Hg in his left eye. After discontinuation of steroids and addition of ocular hypotensive medication, interface fluid collection disappeared in his right eye. Visual acuity improved and haze diminished in both eyes. This case illustrates that in the same patient a post-LASIK edema induced syndrome may be present with or without fluid in the interface, suggesting that both clinical pictures could be manifestations of a broad spectrum of the same condition. We suggest a new name for this non-inflammatory disorder: post-LASIK edema-induced keratopathy (PLEK).

Interface Fluid Syndrome (IFS) following Toxic Anterior Segment Syndrome (TASS): not related to high intraocular pressure but to endothelial failure

“…Furthermore, stages 1 and 2, according to the staging system proposed by Dawson et al, have been called PISK by other researchers,[2], [3] however, as mentioned, the disorder might not be related to IOP, therefore this name does not seem appropriate to describe it. Consequently, Galvis et al in 2012 proposed to call the condition “post-LASIK edema induced keratopathy (PLEK)”, which applies to the whole spectrum of the disorder (both PISK and IFS), and the staging system proposed by Dawson et al could be used to describe it in more detail [4], [5]…”

“…Consequently, Galvis et al in 2012 proposed to call the condition “post-LASIK edema induced keratopathy (PLEK)”, which applies to the whole spectrum of the disorder (both PISK and IFS), and the staging system proposed by Dawson et al could be used to describe it in more detail. [4] , [5] …”

“… [2] , [3] Based on the experimental study of Dawson et al, and since some cases of both IFS and PISK had been reported without the presence of high IOP in 2012 Galvis et al proposed the name Post LASIK edema-induced keratopathy (PLEK) to the condition, in order to exclude the words “pressure induced”, as evidently this is not the etiology in all cases. [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] Recently Luceri et al and Shajari et al reported the first two cases of Descemet Membrane Endothelial Keratoplasty (DMEK) performed to solve and IFS secondary to corneal edema in two patients with Fuchs endothelial dystrophy who developed corneal edema after phacoemulsification without an increase in IOP. [16] , [17] …”

Visual outcomes and management after corneal refractive surgery: A review

“…Galvis et al, proposed to encompass those conditions under the name of post-LASIK edema-induced keratopathy (PLEK). 59 Interface edema is rare beyond 1 week post-LASIK and can occur in patients with Fuch's corneal dystrophy, in patients with high intraocular pressures secondary to steroid treatments post-LASIK (we refer to this condition as pressure-induced stromal keratitis) or in patients in treatment with drugs that slow endothelial pumping function (e.g. carbonic anhydrase inhibitors).…”

The Effect of Corneal Refractive Surgery on Glaucoma

“…Increased IOP leads to a spectrum of clinical manifestations in the cornea that ranges from a simple rise of the IOP to pressure induced stromal keratitis (PISK) and to IFS [ 81 , 82 ]. In the early stages of the IOP rise, there is stromal swelling which causes corneal haze.…”