Purchase this article with an account.
Allison M. Landes, Charles Bouchard; Clinical Findings And Surgical Outcomes Of Patients With Fuch’s Endothelial Dystrophy And Keratoconus. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1112.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To report two cases of Fuch’s dystrophy and keratoconus, one of which is the first reported case to our knowledge to undergo Descemet’s stripping endothelial keratoplasty (DSEK).
We reviewed the clinical findings and surgical outcomes of 2 patients with Fuch’s dystrophy and keratoconus. Clinical examination, corneal topography, central corneal thickness, and endothelial cell density were evaluated as well as surgical outcomes.
Case 1: A 41 year old woman presented to the Loyola Cornea Service with mild bilateral apical scarring and corneal topography consistent with keratoconus. She also had confluent corneal guttata, stromal edema, and mild microcystic edema consistent with Fuch’s dystrophy. Her central corneal thickness was 610 OD and 662 OS. Her visual acuity with spectacle correction was 20/40- OU. With a rigid gas permeable contact lenses her vision improved to 20/25-1 OD and 20/30-1 OS. She was contact lens intolerant and desired improvement in her spectacle vision and elected to have a DSEK procedure in her left eye. Postoperatively, she developed an inferotemporal sectoral graft separation. Rebubbling on post-operative day 16 resulted in only mild improvement in the separation. However, 8 weeks later the separation resolved and her best corrected vision improved to 20/40 OS. The stromal edema subepithelial haze and vision continue to improve. Case 2: A 54 year old female presented with exam findings and corneal topography consistent with keratoconus OD worse than OS. She also had confluent corneal guttata and central corneal thickness measurements of 614 OD and 595 OS. She also had a visually significant cataract in her right eye. Her best corrected spectacle visual acuity OD was 20/60- which improved to 20/40+ with a gas permeable contact lens. She underwent uneventful cataract extraction with posterior chamber lens implant OD. Her best corrected spectacle vision at 4 months postoperatively was 20/25-2. Specular microscopy at that time revealed an endothelial cell density of 929/mm2 OD and 898/mm2 OS.
Patients with Fuch’s dystrophy and keratoconus have been previously described. We report the first case of DSEK in the management of endothelial dysfunction in this patient population. Adherence of the graft may be problematic due to the steep posterior corneal surface in keratoconus. If DSEK is performed for visual loss associated with Fuch’s dystrophy prior to visually significant apical corneal scarring from keratoconus, the progression of the keratoconus might be stabilized. Long term follow up is planned to better assess this hypothesis.
This PDF is available to Subscribers Only