Delayed Steroid Response Causing Graft Edema and Interface Fluid Syndrome after Anterior Lamellar Keratoplasty

Abstract

The purpose of this study is to describe the clinical features and management of delayed steroid response causing graft edema and interface fluid syndrome after anterior lamellar keratoplasty (ALK). A 32-year-old male presented with a significant decrease in vision following removal of sutures at 10 months after ALK. The visual acuity had dropped to 20/500 from 20/80 at the previous visit. Slit-lamp examination revealed edema localized to the graft. High-resolution optical coherence tomography (OCT) demarcated hyperreflectivity at the level of interface with a thickened anterior lamellar graft. The anterior segment was quiet. In view of the clinical and OCT findings, steroid response was suspected. Intraocular pressure (IOP) assessed using multiple methods (rebound, applanation, and dynamic deformation tonometry) revealed raised IOP. Prompt management with antiglaucoma medications and withdrawal of steroids resolved the graft edema and interface fluid. Delayed steroid response can present as interface fluid with graft edema in ALK, similar to that seen after laser assisted in-situ keratomileusis. The condition should be distinguished from stromal graft rejection; accurate assessment of IOP in this situation may be performed by different methods of tonometry.