Interactive Case Reports

Interface fluid syndrome two decades after LASIK surgery following Descemet's stripping automated endothelial keratoplasty

Case Report Details

First Author: Y.Weill ISRAEL

Co Author(s):    D. Zadok   A. Shoshani   A. Abulafia   L. Wasser   E. Gelman   D. Smadja     

Abstract Details

Purpose:

To describe a case of IFS following descemet stripping automated endothelial keratoplasty (DSAEK) 21-years after LASIK surgery.

Setting:

Ophthalmology Department, Shaare Zedek Medical Center, Jerusalem, Israel

Report of Case:

Interface fluid syndrome (IFS) is a rare complication following LASIK surgery, characterized by fluid collection in the flap interface. It has been reported to occur secondary to raised intraocular pressure (IOP) and endothelial insufficiency, typically in the early postoperative period. Late occurrence of IFS is rare and to the best of our knowledge, we present the latest onset documented to date. A 94-year-old male was referred for evaluation due to persistent corneal edema 10-days after DSAEK for pseudophakic bullous-keratopathy. He was treated with topical dexamethasone 0.1% and moxifloxacin 0.5% q.i.d. Past ocular history included bilateral AMD-related macular scarring and cataract extraction 10-years-ago. On examination, visual acuity remained unchanged from the preoperative visit and was counting-fingers at one meter. Intraocular pressure, measured with applanation-tonometry, was 13mmHg. Slit-lamp biomicroscopy showed diffuse corneal edema with attached central DSAEK graft. The anterior-chamber was deep and seemed clear, although visibility was limited. On anterior-segment OCT (AS-OCT) a LASIK flap was evident, with a clear space underneath it. The donor disc was well attached on AS-OCT. Re-query of the patient's son revealed that he underwent myopic LASIK surgery 21-years-ago. An IFS diagnosis was made, presumably as a result of steroid-induced IOP raise, that was masked due to IOP measurement on an elevated LASIK flap. Dexamethasone drops were replaced with cyclosporine 2% eye drops, and topical brimonidine was administered. Two-weeks later the cornea became clear and AS-OCT confirmed the absence of interface fluid.

Conclusion/Take Home Message:

IFS should be considered as a possible cause of corneal edema even decades after LASIK surgery. It is advisable to obtain an AS-OCT scan in the preoperative evaluation prior to performing keratoplasty to rule out IFS as a cause of corneal edema.

Financial Disclosure:

None