Post-LASIK interface fluid syndrome caused by steroid drops

Bamashmus, Mahfouth A.; Saleh, Mahmoud F.

doi:10.1016/j.sjopt.2013.03.003

Cited by 12 publications

(11 citation statements)

References 21 publications

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“…fluid accumulation between the LASIK flap and the stromal bed, is related to high IOP usually due to corticosteroid use in a steroid-responder patient but also because of other causes of acute ocular hypertension. [3] , [7] , [8] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] In some cases it has led to advanced and even terminal glaucoma with severe visual loss because the condition was mistakenly confused with diffuse lamellar keratitis (DLK), and IOP was wrongly considered low due to the erroneous readings of the applanation tonometry performed in the central cornea. [22] , [23] , [24] , [25] The cases of IFS might be more frequent than previously thought since around five percent of the general population is high steroid responders presenting significant increases in IOP (more than 15 mm Hg above baseline), and these medications are used after LASIK and intraocular surgeries.…”

Section: Discussionmentioning

confidence: 99%

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

Galvis

Berrospi

Tello

et al. 2019

Saudi Journal of Ophthalmology

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We describe the case of a 52-year-old female with past history of LASIK, 21 years earlier, without Fuchs’ endothelial dystrophy, who underwent phacoemulsification and intraocular lens (IOL) implantation. During the early postoperative period severe corneal edema, anterior chamber cellularity and iris inflammation presented, accompanied by a clear space along the LASIK interface. Those findings were interpreted as part of a Toxic Anterior Segment Syndrome (TASS) and secondary interface fluid syndrome (IFS). When interface fluid was present, intraocular pressure (IOP) measured in the center of the cornea yielded very low values. In addition, applanation tonometry performed in the corneal periphery, as well as Schiotz tonometry and digital tonometry also indicated that the IOP was not high. Fluid in the interface persisted until a DMEK was carried out 11 months after the phacoemulsification surgery. Five days postoperatively the IFS resolved, confirmed by OCT imaging. The origin of IFS in this case was corneal edema secondary to endothelial cell dysfunction and it was not related to high IOP. This is the first reported case of IFS following TASS, the third case published of DMEK procedure used to solve endothelial failure-related IFS, and the case with the longest time of presentation after LASIK.

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Section: Discussionmentioning

confidence: 99%

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

Galvis

Berrospi

Tello

et al. 2019

Saudi Journal of Ophthalmology

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“…As expected, our results demonstrated an inverse relation between Km and MRSE during the first postoperative month. Early myopic shifts associated with transient fluid swelling, elevated stromal extracellular matrix production, 12 , 13 increased intraocular pressure with postoperative steroid use, 14 and corneal biomechanical changes are documented after surgical perturbation of the cornea. 15 , 16 Increase in Km is a consequence of these suspected mechanisms of myopic shift.…”

Section: Discussionmentioning

confidence: 99%

Long-term changes in keratometry and refraction after small aperture corneal inlay implantation

Moshirfar

Desautels

Walker

et al. 2018

OPTH

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PurposeTo assess longitudinal refractive, keratometric, and topographic changes following KAMRA small-aperture inlay implantation.Design and settingProspective study at a single site refractive surgery center.MethodsFifty patients underwent KAMRA small-aperture corneal inlay implantation for the correction of presbyopia. Uncorrected near visual acuity (UNVA), uncorrected distance visual acuity, manifest refractive spherical equivalent (MRSE), mean keratometry (Km), corneal topography, and surgically induced astigmatism vector analysis assessments were performed preoperatively and at 1, 3, 6, 12, 24, and 36 months postoperatively.ResultsThe study comprises 50 eyes. An average shift of 0.15±0.63 D (range −1.63 to 2.00 D) occurred between preoperative baseline and 36 months. At 36 months, 54% of patients had hyperopic MRSE and 40% had myopic MRSE compared with baseline. Km was significantly elevated at all postoperative measurements compared with baseline, with the largest Km measured at 12 months. Eighty-six percent of patients had UNVA of 20/32 or better and 88% uncorrected distance visual acuity of 20/25 or better at 36 months. Longitudinal corneal topography revealed a pattern of corneal steepening over the body of the inlay and flattening over the aperture, correlating with a hyperopic shift. There was no significant surgically induced astigmatism.ConclusionKAMRA inlay may cause an increase in Km compared with baseline. Corneal steepening may occur in a specific pattern with steepening over the inlay and flattening over the aperture. This topographic pattern causes a hyperopic shift, which may be relevant for subsequent procedures, such as cataract extraction.

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“…Interface fluid syndrome (IFS) is an unusual complication after laser-assisted in-situ keratomileusis (LASIK) that is characterized by diffuse fluid accumulation within the flap interface. Although elevation of intraocular pressure (IOP) is the main sign associated with the IFS [1], falsely low IOP readings after LASIK could mimic the condition and delay an accurate diagnosis [2]. We report the first case of IFS after uncomplicated phacotrabeculectomy in a patient who had undergone LASIK 10 years previously.…”

Section: Introductionmentioning

confidence: 99%

Delayed-Onset Interface Fluid Syndrome After LASIK Following Phacotrabeculectomy

Kim

Jung

Lee

et al. 2019

Preprint

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Background Interface fluid syndrome (IFS) is an unusual complication after laser-assisted in-situ keratomileusis (LASIK). We report the first case of IFS after uncomplicated phacotrabeculectomy in a patient who had undergone LASIK 10 years previously. This case emphasizes the importance of intraocular pressure (IOP) interpretation in eyes that have undergone LASIK. Case presentation A 30-year-old woman with a history of LASIK surgery presented to glaucoma clinic due to uncontrolled IOP despite of maximally tolerable medical treatment. After receiving phacotrabeculectomy, IOP decreased to 3mmHg on the first postoperative day, but again increased up to 21mmHg and a diffuse corneal edema with cloudy flap interface was demonstrated by slit-lamp microscopy. Corneal edema was sustained even after the IOP was lowered to 14 mmHg. Spectral-domain optical coherence tomography scanning of the cornea revealed a diffuse, thin fluid pocket in the corneal interface. After laser lysis of the scleral flap sutures, IOP was further decreased to 9mmHg and interface fluid was resolved. Conclusion IFS should be considered as a possible cause of postoperative corneal edema despite of low IOP in the eyes that underwent LASIK surgery. Additional IOP lowering may be helpful for resolving the corneal edema.

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Post-LASIK interface fluid syndrome caused by steroid drops

Cited by 12 publications

References 21 publications

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

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

Long-term changes in keratometry and refraction after small aperture corneal inlay implantation

Delayed-Onset Interface Fluid Syndrome After LASIK Following Phacotrabeculectomy

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