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Ocular hypertension: case report A 27-year-old man developed ocular hypertension during treatment with prednisolone-acetate. The man had a history of small-incision lenticule extraction. After the procedure, he started receiving topical prednisolone acetate 1% oculus dexter (OD; right eye) 4 times/day for the first week and then daily dose reduced by one drop every week [indication not stated], ofloxacin and artificial tears. At day 1 and week 1 postoperative visits, his uncorrected distance visual acuity (UDVA) was 20/25 OD and 20/20 oculus sinister (OS; left eye). At 1 week, manifest refraction was +0.5 –1.0 x 73 OD and plano OS. After, However, a week later, he developed suddenly worsening symptoms of hazy vision and foreign body sensation, which started 2 days before the visit. His UDVA was 20/30 OS and 20/60 OD. Examination showed a 1.3 mm abrasion of the central cornea OD without any infiltrates. He was advised to continue prednisolone acetate eye drops both eyes (OU), ofloxacin and a bandage contact lens (BCL) was placed in both the eyes. After 2 days, the epithelial defect healed and the BCL was removed. However, new onset of haze in the central cornea OD was observed. Due to suspicion of DLK, he was started on prednisolone acetate eye drops OD every hour while awake for 2 days and then every 2 hours while awake until his further follow-up appointment in 1 week. After 1 week (1 month after operation), he presented with worsening symptoms of cloudy vision OD, mild soreness OU, nausea and headaches. He was treated with ibuprofen for pain relief and prednisolone acetate was continued as prescribed. His UDVA declined to 20/50 OS and 20/250 OD, and manifest sphere was -1.00 OS and -3.00 OD. Slit-lamp examination showed central corneal haze OU and worse OD. Pachymetry readings revealed central corneal thickness (CCT) 620µg OD and 581µg OS, which was found to be higher than the expected corneal thickness. Optical coherence tomography (OCT) imaging showed increased corneal thickness OU along with pockets of interface fluid OD (interface fluid syndrome). Intraocular pressure (IOPs) measured at the center of the cornea were 19mm Hg OS and 25mm Hg OD (ocular hypertension) [duration of treatment to reaction onset not stated]. Based on these findings, he was confirmed to have pressure-induced interlamellar stromal keratitis OU. Prednisolone acetate drops was discontinued and the man was treated with brimonidine/timolol [Combigan]. One week later, he had subjective improvement in visual acuity. Whereas, his pain, nausea and headache had fully resolved. UDVA was 20/25 OS and 20/20 OD. Examination showed a significant improvement in haze OU and OCT showed substantial improvement in corneal oedema OU and resolution of the stromal fluid OD. CCT was found to be 554mm OU. His pressures were also resolved to 9mm Hg OS and 10mm Hg. His treatment was continued on brimonidine/timolol and artificial tears. Moshirfar M, et al. Pressure-Induced Interlamellar Stromal Keratitis After Small-Incision Lenticule Extraction Procedure: