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JAMA Ophthalmology Clinical Challenge
January 3, 2019

Elevated Intraocular Pressure in a Young Man With a History of Laser-Assisted In Situ Keratomileusis

Author Affiliations
  • 1Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
JAMA Ophthalmol. Published online January 3, 2019. doi:10.1001/jamaophthalmol.2018.5430

A 24-year-old South Asian man presented with acute-onset pain and decreased vision in his left eye. His ocular history was significant for high myopia, a long-standing traumatic retinal detachment in his right eye, and laser-assisted in situ keratomileusis (LASIK) surgery of the left eye 8 months earlier. Three months earlier, the patient experienced an episode of elevated intraocular pressure (IOP) of the left eye, which was treated with travoprost ophthalmic solution, 0.004%, and oral acetazolamide and resolved. The patient’s presenting visual acuity was counting fingers OD (baseline) and 20/200 OS. His initial IOPs were right eye 16 mm Hg and left eye 46 mm Hg by TonoPen. Examination of the left eye indicated normal gonioscopy results and unremarkable anterior and posterior segment examination findings except for the presence of corneal edema without keratic precipitates. The patient started treatment with dorzolamide hydrochloride, timolol maleate, brimonidine tartrate, latanoprost, and oral acetazolamide.