Supplementary Material for: Pressure-Induced Stromal Keratopathy After Surface Ablation Surgery

The purpose of this clinical report is to describe an unprecedented case of bilateral pressure-induced stromal keratopathy (PISK) following corneal photorefractive keratectomy (PRK), associated with presumed herpetic keratitis, and to present tomographic and biomechanical findings before and after appropriate treatment. A 33-year-old male patient was referred to our clinic with suspected delayed corneal epithelial healing three weeks after an uncomplicated PRK. A central layer of corneal opacity with a presumed fluid-filled interface area was observed upon slit-lamp biomicroscopy. Scheimpflug images from the Pentacam® revealed a hyperreflective area beneath the central cornea. Scheimpflug-based corneal tomography, biomechanical assessment using the Pentacam® AXL Wave, and the Corvis ST® were conducted. Goldmann applanation tonometry measured 23/13 mmHg, while non-contact tonometry intraocular pressure measured with the Corvis ST® (Corvis ST IOPnct) was 40.5/43.5 mmHg. Treatment with oral valacyclovir, combined with ocular hypotensive therapy, led to a significant reduction in IOP and improved corneal deformation parameters after one month. Surgeons should be aware of the inaccuracy of Goldmann applanation tonometry in pressure-induced stromal keratopathy, which can occur after LASIK or surface ablation.