Scheimpflug-Based Tomography and Biomechanical Assessment in Pressure-Induced Stromal Keratopathy

PURPOSE: To report the tomographic and biomechanical findings before and after treatment of a case of pressure-induced stromal keratopathy (PISK), which was misdiagnosed as diffuse lamellar keratitis (DLK). METHODS: A case report of a referred patient with supposed diagnosis of DLK after LASIK in the right eye. Scheimpflug-based corneal tomography and biomechanical assessment were provided by the Pentacam HR and CorVis ST (Oculus Optikgerate GmbH, Wetzlar, Germany). RESULTS: A layer of corneal opacity beneath the flap with a presumably fluid-filled interface area was observed on slit-lamp biomicroscopy. Scheimpflug image from Pentacam revealed a hyperreflective area underneath the flap interface. Goldmann applanation tonometry was 12 mm Hg, whereas CorVis intraocular pressure was 53.5 mm Hg with deformation amplitude of 0.42 mm. Two days after starting oral and topical ocular hypotensive therapy, CorVis intraocular pressure was 14 mm Hg and deformation amplitude was 1.02 mm. CONCLUSIONS: Ocular hypertension in PISK was associated with lower deformation response, along with steepening and thickening of the cornea.