Fluid Interface Syndrome (Fis) Secondary To Phakic Dmek In A Patient With A History Of Lasik.

To present a clinical case of intraocular pressure-induced stromal keratopathy (PISK) or FIS in a patient undergoing LASIK and affected by Fuchs endothelial dystrophy (FED).

Second-level public hospital (Móstoles, Madrid, Spain). 

We describe a case of FED and previous history of LASIK undergoing phakic DMEK, treated in the Cornea section of Rey Juan Carlos Hospital. The clinical history was reviewed as well as the personal and ophthalmological history. 

A 52-year-old male, phakic, who underwent LASIK in the right eye (OD), consulted due to a decrease in best corrected visual acuity (BCVA) in OD (Snellen 0.3). Guttas were observed in both eyes with cornea thickening in OD. The patient didn´t report a history of refractive surgery and it was not appreciated in the examination due to corneal edema. He was diagnosed with DEF and treated with DMEK in OD. The day after, the cornea was edematous with normal tonometry and OCT revealed fluid in the interface. A diagnosis of PISK was made. Hypotensive treatment was started and steroids were maintained to minimize the rejection. Two weeks later, corneal transparency was achieved with a decrease in fluid and an improvement in BCVA (Snellen 0.8).

In LASIK patients with endothelial dysfunction, it is important to take into account the possibility of PISK after DMEK. Treatment consists of lowering IOP, in addition to DMEK itself. The use of corticosteroids is controversial since they can increase IOP, however, in our case we decided to keep it at 
minimum doses to avoid graft rejection. To our knowledge, this is the first described case of PISK after phakic DMEK, without being able to rule out that the interface fluid was found before the keratoplasty. We believe it is advisable to perform anterior segment OCT in patients with endothelial dysfunction and a history of LASIK to rule out fluid from the interface that simulates corneal edema in the topography.