[Atypical presentation of ocular hypertension following myopic LASIK]. / Presentación atípica de la hipertensión ocular en los pacientes intervenidos de LASIK miópico.

OBJECTIVE: We present a masquerade syndrome recently described following uneventful laser in situ keratomileusis (LASIK). If misdiagnosed or left unattended, this condition can lead to severe visual loss. METHODS: Findings concerning ten patients who underwent uneventful myopic LASIK, but who presented with a granular haze in the interface in the early postoperative period, are described. Initially, some of the patients were treated for diffuse lamellar keratitis with an intensive course of topical steroids, but, rather than improving, the haziness of the interface worsened or remained the same, and was even accompanied by the development of epithelial edema. RESULTS: Tonometry led to the diagnosis of ocular hypertension induced by the steroid therapy. The clinical picture resolved completely with topical hypotensive treatment and with the cessation of steroid treatment. CONCLUSION: In the early postoperative period following LASIK an atypical presentation of ocular hypertension can occasionally be observed. A high index of suspicion of this diagnosis must be maintained due to the inaccuracy of tonometry after LASIK and the similarity of this clinical picture with diffuse lamellar keratitis. These cases emphasize the importance of taking into account underestimation of the intraocular pressure after myopic LASIK.

Presentación atípica de la hipertensión ocular en los pacientes intervenidos de Lasik miópico / Atypical presentation of ocular hypertension following myopic Lasik

Objetivo: Se presenta un síndrome mascarada descrito recientemente en los pacientes sometidos a queratomileusis in situ asistida por láser excimer (LASIK). Si no se diagnostica a tiempo o si no recibe el correcto tratamiento, puede conducir a una pérdida visual severa.Métodos: Se exponen los casos clínicos de diez pacientes intervenidos de LASIK miópico sin incidencias, y que en el postoperatorio precoz presentaron un haze granular en la interfase corneal de ambos ojos. Algunos inicialmente fueron tratados como queratitis lamelares difusas con corticoides tópicos intensivos. La turbidez de la interfase en lugar de mejorar, se mantuvo o empeoró, desarrollando incluso edema epitelial.Resultados: La tonometría condujo al diagnóstico de hipertensión ocular inducida por los esteroides. La clínica se resolvió completamente con tratamiento médico hipotensor tópico y suprimiendo los corticoides.Conclusión: Esta presentación atípica de una hipertensión ocular puede producirse tras un LASIK reciente. La inexactitud en las técnicas tonométricas tras esta cirugía y la similitud del cuadro con la queratitis lamelar difusa deben hacernos mantener un alto índice de sospecha clínica. Estos casos enfatizan la importancia de la subestimación de la PIO tras el LASIK miópico

Objective: We present a masquerade syndrome recently described following uneventful laser in situ keratomileusis (LASIK). If misdiagnosed or left unattended, this condition can lead to severe visual loss.Methods: Findings concerning ten patients who underwent uneventful myopic LASIK, but who presented with a granular haze in the interface in the early postoperative period, are described. Initially, some of the patients were treated for diffuse lamellar keratitis with an intensive course of topical steroids, but, rather than improving, the haziness of the interface worsened or remained the same, and was even accompanied by the development of epithelial edema.Results: Tonometry led to the diagnosis of ocular hypertension induced by the steroid therapy. The clinical picture resolved completely with topical hypotensive treatment and with the cessation of steroid treatment.Conclusion: In the early postoperative period following LASIK an atypical presentation of ocular hypertension can occasionally be observed. A high index of suspicion of this diagnosis must be maintained due to the inaccuracy of tonometry after LASIK and the similarity of this clinical picture with diffuse lamellar keratitis. These cases emphasize the importance of taking into account underestimation of the intraocular pressure after myopic LASIK