Pressure-Induced Stromal Keratopathy after Surface Ablation Surgery

Jaime Guedes; Rodrigo Vilares-Morgado; Rodrigo Brazuna; Alexandre Costa Neto; Denisse Josefina Mora-Paez; Marcella Q Salomão; Fernando Faria-Correia; Renato Ambrósio Jr

doi:10.1159/000539701

Pressure-Induced Stromal Keratopathy after Surface Ablation Surgery

Case Rep Ophthalmol. 2024 Jul 1;15(1):532-541. doi: 10.1159/000539701. eCollection 2024 Jan-Dec.

Authors

Jaime Guedes¹, Rodrigo Vilares-Morgado^{1

2}, Rodrigo Brazuna^{1

3}, Alexandre Costa Neto^{1

3}, Denisse Josefina Mora-Paez¹, Marcella Q Salomão¹, Fernando Faria-Correia^{1

4}, Renato Ambrósio Jr^{1

3

5}

Affiliations

¹ Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil.
² Department of Ophthalmology, Centro Hospitalar Universitário de S. João, Porto, Portugal.
³ Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.
⁴ School of Medicine at the University of Minho, Braga, Portugal.
⁵ Instituto de Olhos Renato Ambrósio and Visare, Rio de Janeiro, Brazil.

Abstract

Introduction: The purpose of this clinical report was to describe an unprecedented case of bilateral pressure-induced stromal keratopathy (PISK) following corneal photorefractive keratectomy, associated with presumed herpetic keratitis, and to present tomographic and biomechanical findings before and after appropriate treatment.

Case presentation: A 33-year-old male patient was referred to our clinic with suspected delayed corneal epithelial healing 3 weeks after an uncomplicated PRK. A central layer of corneal opacity with a presumed fluid-filled interface area was observed upon slit lamp biomicroscopy. Scheimpflug images from the Pentacam^® revealed a hyperreflective area beneath the central cornea. Scheimpflug-based corneal tomography, biomechanical assessment using the Pentacam^® AXL Wave, and the Corvis ST^® were conducted. Goldmann applanation tonometry measured 23/13 mm Hg, while noncontact tonometry intraocular pressure measured with the Corvis ST^® (Corvis ST IOPnct) was 40.5/43.5 mm Hg. Treatment with oral valacyclovir, combined with ocular hypotensive therapy, led to a significant reduction in IOP and improved corneal deformation parameters after 1 month.

Conclusion: Surgeons should be aware of the inaccuracy of Goldmann applanation tonometry in PISK, which can occur after LASIK or surface ablation.

Keywords: Corneal biomechanics; Goldmann applanation tonometry; LASIK; Stromal keratopathy; Surface ablation.

Publication types

Case Reports

Grants and funding

The authors declare that they have no financial ties to declare. No funding or sponsorship was received for this study or publication of this article.