PRESSURE-INDUCED INTERLAMELLAR STROMAL KERATITIS FOLLOWING LASER IN SITU KERATOMILEUSIS (LASIK)
Published 2025 - 29th ESCRS Winter Meeting
Reference: CR03.01 | Type: Case Report (Cornea Day) | DOI: 10.82333/2nt8-qs79
Authors: Dimitra Kopsini* 1 , Nikolaos Bouratzis 2 , Gerasimos Kopsinis 3
1SECOND DEPARTMENT,OPHTHALMIATREION ATHINON SPECIALISED EYE HOSPITAL,ATEHNS,Greece, 2OPHTHALMOLOGY DEPARTMENT,EVANGELISMOS GENERAL HOSPITAL,ATHENS,Greece, 3GLAUCOMA DEPARTMENT,ATHENS VISION EYE INSTITUTE,ATHENS,Greece
Purpose
To describe a case of pressure-induced interlamellar stromal keratitis (PISK) following laser in situ keratomileusis
(LASIK) surgery, that led to glaucomatous optic neuropathy.
Setting
Tertiary referral center.
Report of case
A 28-year-old man underwent uneventful laser in situ keratomileusis (LASIK) for myopia correction in both eyes
(OU). Despite a brief visual acuity improvement post-LASIK, two and a half months postoperatively he mentioned that his
vision failed to improve. Before presenting to our clinic he consulted elsewhere for his symptoms and he was diagnosed
with diffuse lamellar keratitis (DLK), for which an intensive topical steroid treatment was administered. The patient
complained of deteriorating vision despite treatment and visited our clinic. At examination his best-corrected visual acuity
(BCVA) was 20/40 and 20/50, in the right and left eye, respectively. Intraocular pressures (IOP) with Goldmann
applanation tonomery measured 18 mmHg and 22 mmHg in the center of the cornea, but 37 mmHg and 55 mmHg in the
cornea periphery. Slit-lamp examination revealed fluid accumulation in the lamellar interface OU, whereas dilated fundus
examination revealed optic nerves almost totally cupped. OCT RNFL showed decreased RNFL thickness and Humphrey
Visual Fields showed advanced glaucomatous damage. Diagnosis of pressure-induced interlamellar stromal keratitis
(PISK) was made, topical steroids were discontinued and both topical and systemic anti glaucoma treatment was
initiated.
Conclusion / Take home message
PISK is a rare but vision-threatening LASIK complication. It can resemble DLK due to similar appearance, however, corneal haze resistant or even worsening with steroid treatment should alert the clinician towards PISC. IOP measurements at the centre of the cornea might give falsely low levels. Prompt discontinuation of topical steroids and initiation of anti-glaucoma treatment is crucial to avoid optic nerve damage. Complete ophthalmic exam with fundoscopy is always of utmost importance.