Interface Fluid Syndrome After Descemet Membrane Endothelial Keratoplasty

PURPOSE: To describe a case of interface fluid syndrome in a patient with a remote history of laser in situ keratomileusis (LASIK) and recent staged cataract surgery and Descemet membrane endothelial keratoplasty (DMEK). METHODS: A 65-year-old man presented with visual impairment in the left eye in the setting of Fuchs' endothelial dystrophy and cataract. Cataract surgery followed by DMEK 3 months later were performed in the left eye. RESULTS: Following DMEK, a cleft of interface fluid was documented at the LASIK flap interface via anterior segment optical coherence tomography (AS-OCT) 4 days postoperatively. The DMEK graft was fully attached and intraocular pressure (IOP) was low to normal when the interface fluid was first observed. This interface fluid persisted despite management with IOP-lowering drops. IOP consistently measured low, and the DMEK graft subsequently detached inferiorly. The decision was made to perform Descemet stripping automated endothelial keratoplasty (DSAEK), after which the interface fluid resolved and visual acuity improved significantly. CONCLUSIONS: Interface fluid syndrome can occur years after LASIK, especially following intraocular surgery. This patient may have developed interface fluid syndrome following DMEK due to endothelial dysfunction in the setting of DMEK graft incompetence. Resolution of interface fluid in this patient was achieved after DSAEK. [ Journal of Refractive Surgery Case Reports. 2021;1(1):e15–e18.]