Dmek As A Treatment For Non Responding Interface Fluid Syndrome In A Post Lasik Patient With A History Of Herpetic Keratouveitis

Interface fluid syndrome (IFS) is a known complication of laser-assisted in situ keratomileusis (LASIK) which can occur many years after intervention. While it is classically associated with ocular hypertension, cases related to endothelial dysfunction have also been reported. Descemet membrane endothelial keratoplasty (DMEK) is a therapeutic option for IFS that does not respond to hypotensive treatment.

A 56-year-old male with ophthalmic history includingmyopic LASIK in 2004, pseudophakia in the left eye (LE), and recurrent episodes of herpetic keratouveitis in the LE,underwent DMEK in 2021, which failed after 9 months due to herpetic reactivation, leading to a reoperation in March 2023. The second DMEK did not gain clarity and immune rejection was diagnosed. The patient had beentreated with cyclosporine, corticosteroids, anti-herpetic prophylaxis, and hypotensive agents with noimprovement.

On ophthalmic examination, the best-corrected visual acuity (BCVA) in the LE was counting fingers. Slit-lamp evaluation revealed corneal edema with bullae and retrokeratic precipitates. Intraocular pressure (IOP) was 22 mmHg by Goldmann applanation tonometry and 40-50 mmHg by digital palpation. Anterior segment optical coherence tomography (AS-OCT) confirmed the presence of IFS. Immunosuppressive therapy was discontinued, corticosteroid dosage was reduced, and hypotensive treatment was intensified. PCR testing for herpesvirus was negative.

Despite IOP normalization, IFS persisted, prompting a third DMEK in January 2024. Postoperatively, AS-OCT showed resolution of the interface fluid and improvement in corneal edema. However, at five months follow-up, BCVA was 0.2, with good anatomical outcomes and a normal fundus examination. AS-OCT revealed fibrosis at the interface.

IFS should always be considered in cases of post-LASIK corneal edema, with AS-OCT being essential for diagnosis. In this case, DMEK successfully resolved the interface fluid, but its prolonged persistence led to interface fibrosis. Accurate diagnosis and timely management are crucial to prevent scarring that may compromise visual recovery after lamellar keratoplasty.