Interface Fluid Syndrome After Descemet Membrane Endothelial Keratoplasty in Patients With History of LASIK

Abstract

The aim of this study was to evaluate the visual, pachymetric, tomographic, and biomicroscopic findings in a series of cases with laser in situ keratomileusis (LASIK) flap interface fluid syndrome (IFS) after Descemet membrane endothelial keratoplasty (DMEK).Methods: Six cases were included in this study; all patients had a history of LASIK and underwent DMEK for the treatment of bullous keratopathy. After uneventful surgery, all patients presented with corneal edema and IFS under the LASIK flap, which was demonstrated with anterior segment optical coherence tomography (AS-OCT). Visual acuity, clinical findings, pachymetry, endothelial cell count, and AS-OCT were documented during the management of these cases.Results: IFS appears 2.33 days (61.03) after DMEK. One case improved with conservative treatment. In 5 cases, the LASIK flap was lifted, the fluid was drained, and the flap was replaced. The mean best-corrected visual acuity after fluid drainage was 0.44 logMAR (range 0.18-1.0) and mean central corneal thickness was 538 mm 6 160. Total resolution of the IFS was achieved at 14.5 days (range 4-30) after DMEK. AS-OCT showed resolution of the flap interface in 5 of 6 cases, while 1 patient required second DMEK due to reaccumulation of the interface fluid.Conclusions: IFS can occur after DMEK in patients with previous LASIK. AS-OCT is a valuable tool for monitoring these cases preoperatively and postoperatively. Early surgical management is often needed to achieve resolution.

Descemet Membrane Endothelial Keratoplasty as Treatment for Late-Onset Interface Fluid Syndrome After Laser In Situ Keratomileusis

“…tThere have been reported case series of IFS after DMEK and DSAEK; this is a postoperative complication after endothelial keratoplasty in eyes that have had previous LASIK. 16,17,21–25 It is important to note that in our case series, we did not see recurrence of IFS after DMEK. IFS as a postoperative complication after endothelial keratoplasty has been documented to occur due to various factors, such as excessive manipulation of the DMEK donor graft, 22 graft failure, poor donor endothelium and corneal recipient adherence, IOP elevation, fibrous surface irregularities of the donor stroma, 24 and even a diminished oxygen supply induced by the use of a scleral lens.…”

“…16,17,21–25 It is important to note that in our case series, we did not see recurrence of IFS after DMEK. IFS as a postoperative complication after endothelial keratoplasty has been documented to occur due to various factors, such as excessive manipulation of the DMEK donor graft, 22 graft failure, poor donor endothelium and corneal recipient adherence, IOP elevation, fibrous surface irregularities of the donor stroma, 24 and even a diminished oxygen supply induced by the use of a scleral lens. 26 Thus, these factors must be taken into account when treating patients with IFS with DMEK.…”

Letter Regarding: Interface Fluid Syndrome After Descemet Membrane Endothelial Keratoplasty in Patients With History of LASIK

“…Curiously, in this patient, the order of events was the opposite of the cases reported by Izquierdo et al 1 because she developed IFS after corneal edema postphacoemulsification, and subsequently, the condition was successfully reversed through DMEK without requiring additional procedures. On the other hand, in the series by Izquierdo et al, patients with a history of LASIK and intraocular surgery experienced corneal decompensation but did not exhibit IFS and developed IFS after DMEK.…”

“…We read with interest the case series published by Izquierdo et al 1 where six patients who had history of laser in situ keratomileusis (LASIK) presented with interface fluid syndrome (IFS) after undergoing Descemet membrane endothelial keratoplasty (DMEK).…”