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Case Report/Case Series |

Pressure-Induced Stromal Keratopathy as a Result of Ocular Trauma After Laser In Situ Keratomileusis

Xiaoqiang Liu, MD, PhD1; Shiqi Ling, MD, PhD2; Xinrui Gao, MD1; Chong Xu, MD, PhD1; Fang Wang, MD, PhD1
[+] Author Affiliations
1Department of Ophthalmology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
2Department of Ophthalmology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
JAMA Ophthalmol. 2013;131(8):1070-1072. doi:10.1001/jamaophthalmol.2013.1738.
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Importance  Pressure-induced stromal keratopathy is a rare kind of complication of laser in situ keratomileusis (LASIK) that may cause vision loss in affected eyes. Herein, we described the clinical features and treatment of 2 cases of pressure-induced stromal keratopathy due to traumatic hyphema in post-LASIK eyes.

Observations  Two patients sought treatment for painful vision loss after blunt trauma on post-LASIK eyes. On examination, high intraocular pressure was found in the injured eyes. Hyphema was seen in the anterior chamber. High-resolution slitlamp biomicroscopy demonstrated interface hyperreflection, which resembled interface keratitis. However, an isolated pocket of fluid was clearly demonstrated at the level of the LASIK flap interface in the anterior segment optical coherence tomographic images. After topical corticosteroid and antiglaucoma medication, the hyphema and the hyperreflection in the cornea resolved in several days. The intraocular pressure and visual acuity returned to normal levels. Repeated anterior segment optical coherence tomographic examinations revealed completed resolution of the interface fluid.

Conclusions and Relevance  To our knowledge, this is the first report of pressure-induced stromal keratopathy caused by traumatic hyphema. Anterior segment optical coherence tomography plays a unique role in revealing occult interface fluid in post-LASIK eyes, which may masquerade as interface keratitis during slitlamp examination.

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Figure 1.
Case 1

A, Slit view of hyphema in the anterior chamber of the left eye. B, High magnification slitlamp biomicroscopy shows a hyperreflection (arrow) between the laser in situ keratomileusis flap and the stromal bed. C, Anterior segment optical coherence tomography showed interface fluid accumulation (arrow) as optically empty space in the flap-stromal interface of the left eye. The dense hyperreflective spots in the anterior chamber represented hyphema (asterisk). The thicknesses of the flap, interface fluid pocket, and stromal bed were 169 μm, 63.25 μm, and 317 μm, respectively. D, Slitlamp photograph of the left eye shows a complete resolution of hyphema in the anterior chamber. E, High-magnification slitlamp biomicroscopy shows complete resolution of the interface hyperreflection. F, Anterior segment optical coherence tomography shows a complete resolution of the interface fluid and corneal edema. The thicknesses of the flap and stromal bed were 149.5 μm and 271.25 μm, respectively.

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Figure 2.
Case 2

A, Slit view of hyphema in the anterior chamber of the right eye. B, High-magnification slitlamp biomicroscopy showed an interface hyperreflection (arrow). C, Anterior segment optical coherence tomography shows stromal bed edema, interface fluid accumulation (arrow), and hyphema (asterisk) in the right eye. The thicknesses of the flap, interface fluid pocket, and stromal bed were 149.5 μm, 92.75 μm, and 557.5 μm, respectively. D, Slitlamp photograph of the right eye showed clear cornea and anterior chamber. E, High-magnification slitlamp biomicroscopy shows complete resolution of the interface hyperreflection. F, Anterior segment optical coherence tomography shows a complete resolution of the interface fluid and corneal edema. The flap thickness was 143.6 μm and the stromal bed thickness was 402.5 μm.

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