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Charles S. Bouchard, Samir Vira, Usiwoma Abugo, Brian Sperling, Surendra Basti, Sadeer B. Hannush; Surgical Management and Outcomes of Patients with Concurrent Fuchs’ Corneal Endothelial Dystrophy and Keratoconus - A Multi-Center Case Series. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5986.
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To report the surgical management and outcomes of patients with bilateral Fuchs’ corneal endothelial dystrophy (FED) and keratoconus (KCN). This is the first multi-center case series that includes patients with concurrent disease who underwent Descemet’s stripping endothelial keratoplasty (DSEK), penetrating keratoplasty (PKP) or cataract extraction with intraocular lens implantation (CE-IOL).
This is a retrospective case series of 7 eyes of 5 patients with combined FED and KCN who underwent DSEK, PKP, or CE-IOL with one of 3 surgeons at 3 different centers. Clinical information collected included the following: corneal topography, central corneal thickness, and endothelial cell density. Visual outcomes and change in keratometric measurements were evaluated.
All patients had slit lamp and corneal topography findings consistent with combined FED and KCN. 4 of the 5 patients were female with an average age of 57 years. Follow-up for patients ranged from 2 to 40 months (median of 10 months). Four eyes underwent DSEK; two eyes underwent PKP; one eye had CE/IOL. In patients who underwent DSEK, best corrected visual acuity (BCVA) was 20/25 or better in all eyes. Mean keratometry measurements improved in all cases. In patients who underwent PKP, visual acuity improved in both cases. The patient who underwent CE/IOL had BCVA of 20/25 with unchanged keratometry measurement.. One patient who underwent DSEK subsequently developed graft rejection due to poor compliance and eventual graft failure. This patient then underwent PKP with an uneventful post-operative course and post-operative BCVA of 20/20.
Patients with FED and KCN have been previously reported with most of them managed with PKP. We present 4 eyes of 2 patients who were managed with DSEK for the FED. Topographically all these post-DSEK cases had flatter post-operative keratometric measurements. If DSEK is performed for FED prior to visually significant apical corneal scarring from KCN, the progression of the KCN might be stabilized by the DSEK procedure. Long term follow-up is planned to better assess this hypothesis.
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