Pressure-Induced stromal keratopathy immediate recovery after 30-gauge needle paracentesis

Purpose: Pressure-Induced Stromal Keratopathy (PISK) is a rare complication of Laser in situ keratomileusis (LASIK), in which rapid diagnosis and management is crucial to avoid potential severe complications. We report the case of a PISK where the interface fluid disappeared immediately after single 30-gauge needle paracentesis. Methods: A 56-year-old man asked for refractive surgery in his left eye (LE). He reported an old blunt trauma that had required cataract surgery many years before. The endothelial cell count was 1241 cells/mm2. After a first uneventful femtoLASIK treatment a refractive error persisted, therefore flap lifting retreatment was performed. At the one-week postoperative evaluation, PISK was detected, with an intraocular pressure (IOP, rebound tonometer) of 14 mmHg at the centre of the cornea and 31 mmHg at the peripheral cornea. Results: We immediately performed corneal 30-gauge needle paracentesis, which allowed the IOP to lower. Our patient reported rapid subjective vision improvement within the first 30 min and almost complete fluid absorption from the flap interface was noticed after 3 h. A single topical hypotensive drug was then prescribed to avoid any further IOP rise. Three weeks after the procedure the visual acuity was almost fully restored with only a mild residual refractive error. Conclusion: The ocular paracentesis was effective in treating PISK in this case. It could be considered to achieve a rapid IOP lowering in PISK, followed by topical hypotensive drugs to maintain the result. The rebound tonometer proved to be very effective in obtaining a peripheral IOP measurement in this case.