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Fibrinous anterior uveitis following laser in situ keratomileusis.

Parmar P, Salman A, Rajmohan M, Jesudasan NC - Indian J Ophthalmol (2009 Jul-Aug)

Bottom Line: A 29-year-old woman who underwent laser in situ keratomileusis (LASIK) for myopic astigmatism in both eyes presented with severe pain, photophobia and decreased visual acuity in the left eye eight days after surgery.Examination revealed severe anterior uveitis with fibrinous exudates in the anterior chamber, flap edema and epithelial bullae.Laboratory investigations for uveitis were negative and the patient required systemic and intensive topical steroids with cycloplegics to control the inflammation.

View Article: PubMed Central - PubMed

Affiliation: Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirapalli, Tamil Nadu, India.

ABSTRACT
A 29-year-old woman who underwent laser in situ keratomileusis (LASIK) for myopic astigmatism in both eyes presented with severe pain, photophobia and decreased visual acuity in the left eye eight days after surgery. Examination revealed severe anterior uveitis with fibrinous exudates in the anterior chamber, flap edema and epithelial bullae. Laboratory investigations for uveitis were negative and the patient required systemic and intensive topical steroids with cycloplegics to control the inflammation. This case demonstrates that severe anterior uveitis may develop after LASIK and needs prompt and vigorous management for resolution.

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Appearance of the eye two days after starting topical steroids and cycloplegics. Inflammation persisted with a fibrinous exudate in the anterior chamber (white arrow) and early posterior synechiae superiorly. The edge of the LASIK flap is seen (black arrow)
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Figure 0001: Appearance of the eye two days after starting topical steroids and cycloplegics. Inflammation persisted with a fibrinous exudate in the anterior chamber (white arrow) and early posterior synechiae superiorly. The edge of the LASIK flap is seen (black arrow)

Mentions: The patient was started on hourly prednisolone acetate 1% eye drops (Predmet® eye drops, Sun Pharmaceuticals, India) and cyclopentolate 1% eye drops three times daily (Cyclate eye drops®, Cadila Pharamceuticals, India). As systemic examination by an internist proved unremarkable, a routine laboratory screen currently used at our hospital for patients with severe or recurrent anterior uveitis was ordered. This included blood counts, erythrocyte sedimentation rate (ESR), c-reactive protein, Mantoux test, venereal disease research laboratory test (VDRL), chest X-ray, human immunodeficiency virus (HIV) serology and human leukocyte antigen (HLA) typing. These investigations were within normal limits and the patient was HLA B27-negative. As the patient failed to respond adequately after two days of topical steroid therapy with persistence of the uveitis, increase in fibrinous exudates and development of early posterior synechiae [Fig. 1], oral prednisolone 1 mg/kg body weight (Tab Wysolone®, Wyeth Pharmaceuticals, India, 60 mg once daily) was added. The uveitis responded after starting oral steroids and gradually resolved over two weeks. At the end of two weeks, the uveitis had resolved with resolution of the flap edema and return of visual acuity to 20/20 [Fig. 2]. Oral steroids were tapered and stopped over four weeks. Intraocular pressures remained normal throughout.


Fibrinous anterior uveitis following laser in situ keratomileusis.

Parmar P, Salman A, Rajmohan M, Jesudasan NC - Indian J Ophthalmol (2009 Jul-Aug)

Appearance of the eye two days after starting topical steroids and cycloplegics. Inflammation persisted with a fibrinous exudate in the anterior chamber (white arrow) and early posterior synechiae superiorly. The edge of the LASIK flap is seen (black arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2712708&req=5

Figure 0001: Appearance of the eye two days after starting topical steroids and cycloplegics. Inflammation persisted with a fibrinous exudate in the anterior chamber (white arrow) and early posterior synechiae superiorly. The edge of the LASIK flap is seen (black arrow)
Mentions: The patient was started on hourly prednisolone acetate 1% eye drops (Predmet® eye drops, Sun Pharmaceuticals, India) and cyclopentolate 1% eye drops three times daily (Cyclate eye drops®, Cadila Pharamceuticals, India). As systemic examination by an internist proved unremarkable, a routine laboratory screen currently used at our hospital for patients with severe or recurrent anterior uveitis was ordered. This included blood counts, erythrocyte sedimentation rate (ESR), c-reactive protein, Mantoux test, venereal disease research laboratory test (VDRL), chest X-ray, human immunodeficiency virus (HIV) serology and human leukocyte antigen (HLA) typing. These investigations were within normal limits and the patient was HLA B27-negative. As the patient failed to respond adequately after two days of topical steroid therapy with persistence of the uveitis, increase in fibrinous exudates and development of early posterior synechiae [Fig. 1], oral prednisolone 1 mg/kg body weight (Tab Wysolone®, Wyeth Pharmaceuticals, India, 60 mg once daily) was added. The uveitis responded after starting oral steroids and gradually resolved over two weeks. At the end of two weeks, the uveitis had resolved with resolution of the flap edema and return of visual acuity to 20/20 [Fig. 2]. Oral steroids were tapered and stopped over four weeks. Intraocular pressures remained normal throughout.

Bottom Line: A 29-year-old woman who underwent laser in situ keratomileusis (LASIK) for myopic astigmatism in both eyes presented with severe pain, photophobia and decreased visual acuity in the left eye eight days after surgery.Examination revealed severe anterior uveitis with fibrinous exudates in the anterior chamber, flap edema and epithelial bullae.Laboratory investigations for uveitis were negative and the patient required systemic and intensive topical steroids with cycloplegics to control the inflammation.

View Article: PubMed Central - PubMed

Affiliation: Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirapalli, Tamil Nadu, India.

ABSTRACT
A 29-year-old woman who underwent laser in situ keratomileusis (LASIK) for myopic astigmatism in both eyes presented with severe pain, photophobia and decreased visual acuity in the left eye eight days after surgery. Examination revealed severe anterior uveitis with fibrinous exudates in the anterior chamber, flap edema and epithelial bullae. Laboratory investigations for uveitis were negative and the patient required systemic and intensive topical steroids with cycloplegics to control the inflammation. This case demonstrates that severe anterior uveitis may develop after LASIK and needs prompt and vigorous management for resolution.

Show MeSH
Related in: MedlinePlus