Clinical characteristics of interface fluid syndrome after LASIK: a systematic review / 中华实验眼科杂志

Objective:To evaluate the clinical features of interface fluid syndrome (IFS) after laser in situ keratomileusis (LASIK).Methods:We searched PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure Database, Wanfang Database, and Chinese Science and Technology Periodical Database for literature reports on IFS published from 1999 to 2021.Article selection, data extraction, quality rating, and data analysis were performed with reference to the PRISMA statement for priority reporting entities of systematic reviews and Meta-analysis.Results:A total of 30 publications were included, including 46 cases (62 eyes). Among them, 34 cases (47 eyes) were male and 12 cases (15 eyes) were female.Age ranged from 19 to 69 years with a mean of (36.57±13.40) years.There were 16 cases of bilateral eyes and 30 cases of monocular eyes.The 85.48% (53/62) of IFS was due to increased intraocular pressure (IOP) after LASIK.All 62 eyes included had decreased visual acuity.The 24.19% (15/62) of the affected eyes had ocular pain, redness, and photophobia.All 46 patients showed different degrees of corneal edema and interface fluid.Keratic precipitates and anterior chamber cells were visible in 9.68% (6/62) of the affected eyes, and 16.13% (10/62) showed visual field damage.IOP-lowering eye drops were given to 77.42% (48/62) of eyes.Of the 31 patients (40 eyes) with prognostic descriptions, and 75.00% (30/40) recovered their vision with treatment and 25.00% (10/40) did not.Conclusions:IFS is a rare complication after LASIK.It should be considered in patients with corneal edema after LASIK.Proper measurement of IOP and reasonable application of glucocorticoids and IOP-lowering drops can prevent irreversible vision loss.

Reversal of laser in situ keratomileusis interface fluid after Descemet stripping automated endothelial keratoplasty for pseudophakic bullous keratopathy

To report a case of interface fluid syndrome (IFS) after laser-assisted in situ keratomileusis (LASIK) in a patient with Anterior chamber intraocular lens (ACIOL) induced corneal decompensation treated with Descemet's stripping automated endothelial keratoplasty (DSAEK). At 6 months follow-up, the cornea became clear with improvement in visual acuity and resolution of interface fluid.

Delayed-Onset Interface Fluid Syndrome after LASIK Surgery in Traumatic Hyphema

A 50-year-old female was referred to our clinic with visual disturbance, hyphema and increased intraocular pressure (IOP) in her right eye 7 days after experiencing blunt trauma in that eye. She had undergone uncomplicated laser in situ keratomileusis (LASIK) on both eyes 10 years earlier. At initial examination, the best corrected visual acuity (BCVA) in her right eye was counting fingers at 2 feet with no correction. Central Goldmann applanation tonometry (GAT) showed an IOP of 7 mm Hg. Peripheral digital tonometry showed the IOPs in her right eye superiorly, nasally, temporally, and inferiorly were 36 mm Hg, 35 mm Hg, 34.5 mm Hg and 36.5 mm Hg, respectively. Slit-lamp examination showed diffuse epithelial and stromal edema and a blood clot 1 mm in height in the anterior chamber. Spectral domain scanning laser ophthalmoscope/optical coherence tomography (SD-SLO/OCT) images showed a pocket of fluid between the LASIK flap and the underlying stroma. The patient was started on anti-inflammatory agent and IOP lowering agents. After 15 days of treatment, IOP measured with GAT was 10 mm Hg, slit-lamp examination showed that epithelial and stromal edema had disappeared, and OCT showed no fluid between the corneal flap and stroma.

Misleading Goldmann applanation tonometry in a post-LASIK eye with interface fluid syndrome.

A 21-year-old myope presented with decreased vision and corneal edema following vitreoretinal surgery for retinal detachment. While intraocular pressure (IOP) measurement with Goldmann applanation tonometer (GAT) was low, the digital tonometry indicated raised pressures. An interface fluid syndrome (IFS) was suspected and confirmed by clinical exam and optical coherence tomography. A tonopen used to measure IOP through the peripheral cornea revealed elevated IOP which was the cause of the interface fluid. Treatment with IOP-lowering agents resulted in complete resolution of the interface fluid. This case is being reported to highlight the fact that IFS should be suspected when there is LASIK flap edema and IOP readings using GAT are low and that GAT is not an optimal method to measure IOP in this condition. Alternative methods like tonopen or Schiotz tonometry can be used.

A Wide Discrepancy between Intraocular Pressure by Applanation and Non-contact Tonometry after LASIK

PURPOSE: To report the case of a glaucoma patient with a history of LASIK surgery who presented with a wide discrepancy in intraocular pressure between the Goldmann applanation tonometry and non-contact tonometry. METHODS: A 20-year-old male glaucoma patient was referred to our clinic with a chief complaint of blurred vision in his right eye. The patient had a history of uneventful bilateral LASIK surgery. Upon our initial examination, his best-corrected visual acuity in the right eye was 0.04 and his right eye IOP was 14 mmHg by Goldmann applanation tonometry and 40 mmHg by non-contact tonometry. A slit lamp examination showed corneal epithelial edema with diffuse interface opacities. The central corneal thickness in the right eye was 587 micrometer. An ultrabiomicroscopy demonstrated an interface fluid accumulation between the LASIK flap and the stromal bed. The patient was diagnosed with juvenile open-angle glaucoma and was scheduled for a trabeculectomy. RESULTS: Seven days after trabeculectomy, the patient's vision in the right eye improved to 0.7 and his IOP was 12 mmHg by Goldmann applanation tonometry and 14 mmHg by non-contact tonometry. In addition, the corneal epithelial edema, interface opacities, and fluids had all resolved and the central corneal thickness was reduced to 489 micrometer. CONCLUSIONS: In eyes that have undergone LASIK surgery, the IOP measured by Goldmann applanation tonometry may underestimate the true pressure due to fluid accumulation under the LASIK flap. In such cases, non-contact tonometry can be a convenient and a reliable method for determining treatment plan.