Shoji Nobuyuki, Ishida Akira, Haruki Takahiro, Matsumura Kazuhiro, Kasahara Masayuki, Shimizu Kimiya
From the Orthoptics and Visual Science Course (NS), Kitasato University School of Allied Health Sciences; and Department of Ophthalmology (NS, AI, TH, KM, MK, KS), Kitasato University Hospital, Kanagawa, Japan.
Medicine (Baltimore). 2015 Sep;94(39):e1609. doi: 10.1097/MD.0000000000001609.
This study sought to describe a glaucoma patient with interface fluid syndrome (IFS) induced by uncontrolled intraocular pressure (IOP) without triggering factors after laser in situ keratomileusis (LASIK). Case report and review of the literature. A 23-year-old man with open-angle glaucoma underwent bilateral LASIK for myopia in 2009. Two years later, the patient reported sudden vision loss. The IOP in the right eye was not measurable using Goldmann applanation tonometry (GAT), but was determined to be 33.7 mm Hg using a noncontact tonometer. IFS was diagnosed based on the presence of space-occupying interface fluid on anterior segment optical coherence tomography images. After a trabeculectomy was performed, the IOP decreased to 10 mm Hg, and GAT measurement became possible. However, the corneal fold remained visible in the flap interface. Six months later, the IOP in the left eye increased, and a trabeculectomy was performed during the early stages of this increase in IOP. Following this procedure, the IOP decreased, and visual acuity remained stable. In glaucoma cases that involve a prior increase in IOP, IOP can continue to increase during the disease course even if temporary control of IOP has been achieved. If LASIK is performed in such cases, the treatment of glaucoma becomes insufficient because of underestimation of the typical IOP. In fact, the measurement of IOP can become difficult because of high-IOP levels. Therefore, LASIK should not be performed on patients with glaucoma who are at high risk of elevated IOP.
本研究旨在描述一名在准分子原位角膜磨镶术（LASIK）后因眼压失控且无触发因素而诱发界面液综合征（IFS）的青光眼患者。病例报告及文献综述。一名23岁的开角型青光眼男性于2009年接受了双眼LASIK治疗近视。两年后，患者报告突然视力丧失。右眼眼压使用Goldmann压平眼压计（GAT）无法测量，但使用非接触眼压计测定为33.7 mmHg。根据眼前节光学相干断层扫描图像中存在占位性界面液诊断为IFS。小梁切除术后，眼压降至10 mmHg，且GAT测量成为可能。然而，角膜瓣界面的角膜褶皱仍可见。六个月后，左眼眼压升高，在眼压升高的早期阶段进行了小梁切除术。该手术后，眼压降低，视力保持稳定。在既往眼压升高的青光眼病例中，即使眼压已实现临时控制，眼压在病程中仍可能继续升高。如果在此类病例中进行LASIK，由于对典型眼压的低估，青光眼的治疗将变得不足。事实上，由于眼压水平高，眼压测量可能会变得困难。因此，对于眼压升高风险高的青光眼患者不应进行LASIK。
