Traumatic Corneal ThirdSpacing After LASIK Surgery

1
Traumatic Corneal Third-Spacing After LASIK
Surgery

• Jeffrey J. Ing, M.D., F.A.C.S.
• Delta Eye Medical Group
• Assistant Clinical Professor
• Loma Linda University Department of Ophthalmology
• Vahid Feiz, M.D.
• Assistant Clinical Professor
• UC Davis Department of Ophthalmology

2
Introduction

• Fluid in the Interface between the LASIK flap and
  the stromal bed has been described in association
  with steroid induced glaucoma3,4,6,7,8 , after
  trabeculectomy1, and anterior uveitis.2,5
• We describe a case of third-spacing or fluid in
  a potential space the interface between the
  LASIK flap and the stromal bed --associated with
  trauma four months after a LASIK enhancement
  procedure.

3
History

• 36 year old Caucasian male with a history of
  bilateral LASIK seven months previous. Four
  months ago he had an enhancement to his left eye.
  
• His preoperative refraction was
• OD 3.000.75X30 20/20
• OS -3.501.00X107 20/20
• His postoperative refraction was
• OD plano 20/20
• OS -0.250.25X 20/20

4
The accident

• On 5/5/06 the patient was working in the yard
  when he was struck in the left eye cornea with a
  thorn from the bull thistle cirsium vulgare

5
Presentation

• Initial Examination
• scVA 20/20 OD and 20/400 OS
• Conjunctival injection
• Localized microcystic edema
• Anterior chamber deep IOP 14
• Patient was placed on prednisolone acetate and a
  4th generation fluoroquinolone and referred to
  the corneal specialist

6
Consultation

• A full thickness corneal perforation was noted.
  Stromal edema and a faint cleft between the LASIK
  flap and the stromal bed was seen.

7
Proposed Mechanism

• A localized area of peripheral epithelial
  ingrowth was present at the inferior/temporal
  edge of the flap, the fluid in the interface
  continued to flow through the wound and exit
  peripherally with a positive seidel away from the
  injury site at the area of epithelial ingrowth

8
Proposed Mechanism
thorn
Aqueous Leak
9
Endothelial Cell Density

• Normal endothelial density

10
Treatment

• Patient was treated with a tight therapeutic
  bandage contact lens in association with UC
  Davis. The interface fluid disappeared, the
  corneal edema resolved over a several week period
  and the patients vision has returned to
  pre-injury levels. His cornea remains with a
  small scar, but 20/20 without symptoms. His
  epithelial ingrowth remains unchanged.

11
Conclusions

• In the early postoperative period, the interface
  between the LASIK flap and stromal bed exist as a
  potential space for third-spacing of aqueous
  fluid. Although previously reported in
  association with steroid induced glaucoma,
  uveitis, and trabeculectomy, this can occur in
  association with trauma.

12
Conclusions continued

• Epithelial ingrowth may have contributed to the
  continued egress of fluid from the anterior
  chamber to the interface and then to the corneal
  surface. It is not known how long after LASIK
  this interface will remain as a potential space
  for the collection of fluid.

13
References

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•  
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•  
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