The anatomy of the LASIK interface allows for a variety of potential complications to arise, unique etiologies with overlapping clinical presentations. Primary interface complications include infectious keratitis, diffuse lamellar keratitis (DLK), central toxic keratopathy (CTK), pressure-induced stromal keratopathy (PISK), and epithelial ingrowth. Infectious keratitis is most commonly caused by Methicill in resistant S. aureus (early onset) or atypical Mycobacterium (late onset) postoperatively, and immediate treatment includes flap lift and irrigation, cultures, and initiation of broad-spectrum topical antibiotics, with possible flap amputation for recalcitrant cases. DLK is a white blood cell infiltrate that appears within the first 5 days postoperatively and is acutely responsive to aggressive topical and oral steroid use in the early stages but may require flap lift and irrigation to prevent flap necrosis if inflammation worsens. In contrast, PISK is caused by acute steroid response and resolves only with cessation of steroid use and IOP lowering. Without appropriate therapy PISK can result in severe optic nerve damage. CTK mimics stage 4 DLK but occurs early in the postoperative period is non-inflammatory. Observation is the only effective treatment, and flap lift is usually not warranted. Epithelial ingrowth is easily distinguishable from other interface complications and may be self-limited or require flap lift to treat irregular astigmatism and prevent flap melt. Differentiating between interface entities is critical to rapid appropriate diagnosis, treatment, and ultimate visual outcome. While initial presentations may overlap significantly, the conditions can be readily distinguished with close follow-up and most complications can resolve without significant visual sequelae when treated appropriately.

Purpose To report spontaneous corneal clearing with improved visual acuity and central endothelial cell repopulation after Descemet’s stripping without endothelial replacement. Design Interventional case report. Methods A 34 year-old female with bilateral decreased vision secondary to corneal edema from endothelial dysfunction underwent Descemet’s stripping endothelial keratoplasty (DSEK) in the right eye and Descemet’s stripping (DS) only in her contralateral eye. Histopathologic evaluation confirmed a dual diagnosis of Fuchs endothelial dystrophy (Fuchs) and posterior polymorphous membrane dystrophy (PPMD) from Descemet’s membrane specimens removed from each eye. Following primary graft failure with regraft in the right eye, the second posterior corneal lenticule detached, was removed and was not replaced. The cornea cleared and central endothelial cell repopulation was documented by confocal microscopy. Therefore, Descemet’s stripping without endothelial replacement was performed in the left eye. The left cornea also cleared with central endothelial cell repopulation. Main Outcome Measures Postoperative visual acuity and central endothelial cell repopulation Results Endothelial migration after Descemet’s stripping alone in the second eye, with probably host endothelial cell repopulation in the right eye. Conclusions Endothelial cell migration after Descemet’s stripping procedure without insertion of endothelial graft can occur, resulting in host endothelial cell repopulation with corneal clearing and improved visual acuity.

AK remains challenging to diagnose. Consequently, patients with advanced disease are more likely to have poor outcomes, particularly if they are older. The increasing awareness of AK among general eye care providers may shorten referral times and potentially improve outcomes.