Potential Complications of Ocular Surgery in Patients with Coexistent Keratoconus and Fuchs’ Endothelial Dystrophy

PurposeTo describe the potential complications of cataract and refractive surgery in patients with Fuchs’ endothelial dystrophy (FED) and keratoconus.DesignRetrospective case series.ParticipantsEight patients with FED and keratoconus in a large university group practice.MethodsWe reviewed the clinical and topographic findings of 8 patients (15 eyes) with FED and keratoconus. Clinical examination, corneal topography, specular microscopy were done, and sequential central corneal thickness (CCT) was obtained. Follow-up ranged from 1 month to 6 years.Main Outcome MeasuresFindings of keratoconus and FED in preoperative evaluation.ResultsFive patients had concomitant cataracts; 3 had refractive errors and sought surgical correction. Cataract surgery was performed on 3 of 5 patients (5 eyes). LASIK was performed on one eye of 3 patients. Of 5 eyes that underwent cataract extraction, 4 had blurry vision after surgery. The interval between the surgical procedure and onset of symptoms ranged from 1 month to 4 years. The causes of decreased vision after cataract surgery were corneal edema and/or corneal ectasia. The CCT readings ranged from 426 to 824 μm. One of 4 symptomatic eyes underwent penetrating keratoplasty. The CCTs of 3 patients (6 eyes) who presented with refractive error ranged from 507 to 565 μm. One eye had undergone an attempted LASIK procedure resulting in a lost cap. Corneal topography and specular microscopy showed the coexistence of keratoconus and FED, and the patients were advised against having LASIK surgery.ConclusionsCorneal thinning caused by keratoconus and concurrent increase in corneal thickness caused by FED may combine to normalize the corneal pachymetry readings; disease severity may be underestimated, which may lead to unexpected postoperative visual outcomes. Routine use of preoperative topography and specular microscopy may help to avert potential surgical complications.