Endothelial Pump Failure Following Refractive Iol Placement In A Post-Lasik Patient

To report a case of endothelial pump failure in a 36-year-old male with a history of LASIK surgery and subsequent refractive intraocular lens (IOL) placement, highlighting the role of optical coherence tomography (OCT) in diagnosis and differentiating it from interface fluid syndrome (IFS). This case underscores the potential risks associated with multiple refractive procedures, including progressive endothelial decompensation and fluid accumulation between the cornea and the IOL.   Dawson et al has talked about similar findings as well indicating that pressure induced stromal keratopathy (PISK) is merely an initial stage of IFS and that may also occur without increased intraocular pressure (IOP) when the endothelial pump failed

An eye care center specializing in refractive and corneal disorders. The patient presented with progressive visual decline following sequential refractive IOL implantation after prior LASIK surgery.  

 A 36-year-old male with a history of LASIK surgery 13 years ago underwent refractive IOL implantation in the right eye in 2023 and then again in the right eye in 2024. He presented with blurred vision, worsening over weeks. On slit-lamp examination, corneal edema was noted. Anterior segment OCT revealed fluid accumulation was within the lasik flap in between the layers of cornea, raising concerns about endothelial dysfunction.  

Given the history of LASIK, IFS was considered; OCT confirmed that the fluid was within the LASIK flap interface, however later it was found that the endothelial pump was not working when checked with specular microscopy in which the cell count was 600. This finding differentiated it from PISK, a condition associated with steroid-induced intraocular pressure (IOP) elevation leading to fluid accumulation at the LASIK interface. The patient had normal IOP, ruling out PISK and supporting primary endothelial failure. 

Pseudophakic bullous keratopathy (PLEK) was also considered, as it can result from endothelial cell loss following IOL implantation. The patient’s history of multiple refractive surgeries likely contributed to cumulative endothelial damage, exacerbated by surgical trauma from IOL placement. Treatment included topical hypertonic agents and intraocular pressure modulation, with endothelial keratoplasty considered as a definitive intervention. 

This case highlights the risk of endothelial decompensation following multiple refractive surgeries. While interface fluid syndrome should be considered in post-LASIK patients, OCT is essential for distinguishing it from endothelial pump failure. Just as stated in huertas bello et al surgeons should exercise caution when performing additional intraocular procedures in post-LASIK eyes, as cumulative endothelial damage may predispose to corneal decompensation. Early recognition with OCT and timely intervention can help prevent vision-threatening complications.