Diagnosis of steroid-induced elevated intraocular pressure and associated lamellar keratitis after laser in situ keratomileusis using optical coherence tomography

A 52-year-old man had laser in situ keratomileusis (LASIK) for treatment of a post-keratoplasty refractive error. At the 6-week postoperative visit, haziness was noted in the donor cornea and Snellen visual acuity had decreased to 20/400. Goldmann applanation tonometry revealed an intraocular pressure (IOP) of 2 mm Hg at the center of the cornea but an elevated IOP at the periphery. Visante optical coherence tomography (OCT) and corneal topography were performed, and steroid-induced lamellar keratitis (SILK) was diagnosed. Topical antiglaucoma medications were started, and steroid treatment was switched to fluorometholone. At the last follow-up visit, 2 weeks after treatment was started, the visual acuity was 20/60 and the IOP was controlled at 18 mm Hg centrally and at the periphery. The use of Visante OCT and corneal topography were helpful in diagnosing SILK and monitoring its resolution.