OCULAR SURGERY NEWS 10/1/2004
Transient light sensitivity a minor complication of IntraLase use
The syndrome affects less than 1% of IntraLase patients and resolves quickly with aggressive steroid use.
"Now that it's been identified, it's great. When patients show signs, I can put a name to it."
? Daniel S. Durrie, MD
A syndrome investigators are calling transient light sensitivity has been identified as a postoperative complication of IntraLase flap creation. The syndrome, which does not affect visual acuity, is seen in less than 1% of patients and typically resolves with a short, aggressive course of steroids.
Some users of the IntraLase femtosecond laser keratome first noticed the complication when they began working with the system more than 2 years ago. Since then, the phenomenon has gone under multiple names.
?Patients would walk into the office with two pairs of sunglasses on and a baseball cap,? said Brian R. Will, MD, director of Will Vision & Laser Centers in Vancouver, Wash. ?No one knew what to make of the symptoms ? light sensitivity, preserved visual acuity and no slit-lamp findings.?
Dr. Will coined the term track-related iridocyclitis and scleritis (TRISC) syndrome to describe the condition he thought was due to gas bubbles and debris migrating toward the limbus during LASIK with IntraLase.
Karl G. Stonecipher, MD, another early user of IntraLase, called the syndrome good acuity plus photophobia (GAPP). ?It?s similar to the late-onset inflammation we once saw with PRK,? Dr. Stonecipher, of Greensboro, N.C., told Ocular Surgery News. He believed that the inflammation was due to activated keratocytes in the interface.
As time passed, speculation grew among users. Surgeons became concerned about the cause and identity of the rare aftereffect of IntraLase flap creation.
?It was scary when we didn?t know what it was ? frightening to the surgeon and the patient,? said Daniel S. Durrie, MD, director of Durrie Vision in Overland Park, Kan.
Transient light sensitivity
In July, IntraLase surveyed users of its system and discovered that the apparent photophobia phenomenon was unique to LASIK cases using IntraLase for creation of the flap.
?Transient light sensitivity, or TLS, is the term coined by IntraLase to describe the complication,? Dr. Durrie said.
?Once TLS and an effective treatment for the syndrome were identified, it was a relief to everyone,? Dr. Will said. ?It was hard to treat something when you didn?t know what in the world it was.?
?Now that it?s been identified, it?s great,? Dr. Durrie said. ?When patients show signs, I can put a name to it, say, ?Oh, you have TLS. This is a known condition. It responds to steroids, and then it goes away for good.??
Symptoms
TLS symptoms manifest 2 to 6 weeks after surgery.
?Patients? eyes appear fine. There is no visual acuity loss, diffuse lamellar keratitis, redness, dry eye or inflammation inside or outside the eye ? just light sensitivity,? said Perry Binder, MD, of the GordonBinder Vision Institute in San Diego.
Photophobia can be mild to severe, depending on the duration of symptoms at the time patients present.
?When patients wait 3 to 4 weeks, photophobia is usually moderate and easily treated. But when they wait 6 to 8 weeks after first noticing the symptoms or the diagnosis is delayed, it?s usually much worse,? Dr. Will said. Light sensitivity typically occurs bilaterally and is more common in patients with blue irides, he noted.
Dr. Stonecipher noted a higher incidence of TLS among female patients. ?There is a female preponderance of 75%,? Dr. Stonecipher said.
Along with normal visual acuity, patients? anterior segments appear normal with no iritis, cellular flare, corneal staining or anomaly, episcleritis, or redness in the conjunctiva/sclera. Patients with severe photophobia may complain of pain on upward gaze, Dr. Will said.
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