LoBue Stephen, Coleman Kelli, Lam Peter, Shelby Christopher, Coleman Wyche T
Department of Ophthalmology, Willis-Knighton, Shreveport, USA.
Department of Ophthalmology, Louisiana State University Health Sciences Center, Shreveport, USA.
Cureus. 2023 Mar 28;15(3):e36832. doi: 10.7759/cureus.36832. eCollection 2023 Mar.
A 34-year-old male with no past medical or ocular history underwent bilateral uncomplicated small incision lenticule extraction (SMILE). On day 1, uncorrected distance visual acuity (UDVA) was 20/25 in the right eye (OD) and 20/20 in the left eye (OS). The intraocular pressure (IOP) was 12 mmHg in both eyes (OU). On day 17, UDVA was 20/70 OD and 20/30+2 OS. Slit-lamp examination (SLE) revealed diffuse 2+ haze at the interface suspicious for diffuse lamellar keratitis (DLK). Topical difluprednate was added twice a day (BID). Vision decreased by day 20 with a significant myopic shift and 3+ interface haze OU. A washout of the interface was performed. Topical steroids were increased with oral prednisone. One day after the washout, vision and interface haze improved. On day 3 status post washout, UDVA decreased to 20/70 OD and 20/50 OS. IOP was 42 mmHg OU. A diagnosis of interface fluid syndrome (IFS) was confirmed. All steroids were stopped while adding ocular hypotensive medication. One month later, visual acuity was 20/20 OU with a complete resolution of interface haze. Only a handful of IFS has been documented in SMILE, an incidence that may increase as SMILE becomes more common. Among all SMILE cases, IFS was most commonly associated with steroid-induced ocular hypertension and a myopic shift around 21 days postoperatively. A fluid cleft at the interface may not always be visible with SLE, masquerading as DLK. Scheimpflug densitometry and anterior segment optical coherence tomography (AS-OCT) may aid in quantifying interface edema needed to confirm a diagnosis when IOP is unclear. A corneal washout can immediately improve corneal edema, but the preferred treatment is discontinuing all steroid medication and starting glaucoma drops.
一名34岁男性，既往无内科及眼科病史，接受了双眼无并发症的小切口透镜切除术（SMILE）。术后第1天，右眼（OD）未矫正远视力（UDVA）为20/25，左眼（OS）为20/20。双眼眼压（IOP）均为12 mmHg。术后第17天，右眼UDVA为20/70，左眼为20/30+2。裂隙灯检查（SLE）显示界面弥漫性2+混浊，怀疑为弥漫性板层角膜炎（DLK）。加用了0.05%双氟泼尼酯滴眼液，每日两次（BID）。到第20天时视力下降，伴有明显近视漂移，双眼界面混浊达3+。对界面进行了冲洗。增加了局部类固醇药物剂量并加用口服泼尼松。冲洗后1天，视力和界面混浊情况改善。冲洗术后第3天，右眼UDVA降至20/70，左眼降至20/50。双眼眼压为42 mmHg。确诊为界面积液综合征（IFS）。停用所有类固醇药物，同时加用降眼压药物。1个月后，双眼视力均为20/20，界面混浊完全消退。在SMILE手术中，仅有少数IFS病例被记录，随着SMILE手术越来越普遍，其发生率可能会增加。在所有SMILE病例中，IFS最常与类固醇诱导的高眼压以及术后约21天的近视漂移相关。界面处的液性间隙在SLE检查时可能并不总是可见，容易误诊为DLK。当眼压情况不明确时，Scheimpflug密度测量法和眼前节光学相干断层扫描（AS-OCT）可能有助于量化界面水肿以确诊。角膜冲洗可立即改善角膜水肿，但首选治疗方法是停用所有类固醇药物并开始使用青光眼滴眼液。
