Inflammatory Keratitis and IOP Spike After Repeat SLT in Pseudoexfoliation Glaucoma: Case Report and Literature Review

INTRODUCTION: Selective laser trabeculoplasty (SLT) is widely used to lower intraocular pressure (IOP) in glaucoma, including pseudoexfoliation glaucoma (PXG). While transient IOP elevations and mild inflammation are common, delayed keratitis with a secondary IOP spike remains rare. We present a case of inflammatory keratitis and delayed IOP elevation following repeat SLT in a patient with PXG and no prior history of herpes simplex virus (HSV) infection. CASE PRESENTATION: A 59-year-old man with PXG underwent repeat SLT in the left eye. He had a normal IOP reading 1 hour after the procedure. Five days later, he developed blurry vision, keratic precipitates (KPs), superficial punctate keratopathy, trace anterior chamber cells, and an IOP spike to 32 mm Hg. He denied any HSV history. Treatment with topical corticosteroids, IOP-lowering agents, and oral valacyclovir led to resolution of inflammation, though IOP remained elevated despite maximal medical therapy. CONCLUSION: Delayed corneal inflammation with IOP rise following SLT may reflect either viral reactivation or a noninfectious inflammatory response, particularly in eyes with pseudoexfoliation-related structural vulnerability. Awareness of this potential complication underscores the importance of discussing warning signs and symptoms with patients and consideration of empiric anti-inflammatory or antiviral therapy when KPs or corneal edema appear.