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Corneal Decompensation After Laser In Situ Keratomileusis in Fuchs' Endothelial Dystrophy

Dastjerdi, Mohammad H. M.D.; Sugar, Alan M.D.

Case Reports

Purpose. To report corneal decompensation after laser in situ keratomileusis (LASIK) in a patient with Fuchs' endothelial dystrophy.

Methods. Observational case report.

Results. A 47-year-old woman with cornea guttata without symptoms or findings of corneal edema had uneventful LASIK for −5.50 −0.50 × 150 in the right eye and −4.00 −1.25 × 170 in the left eye. Postoperatively, she developed corneal edema, with significant loss of best-corrected visual acuity in both eyes. Preoperative corneal thickness was 587 μm in the right eye and 549 μm in the left eye, measured by ultrasound pachymetry. These readings were 550 and 560 μm on day 67 postoperatively. Endothelial cell counts showed means of 1,209 and 1,661 cells/mm2 in the right and left eyes, respectively.

Conclusion. Caution is suggested when considering LASIK in eyes with severe cornea guttata.

Laser in situ keratomileusis (LASIK) for the correction of myopia and astigmatism has been effective, predictable, stable, and safe. 1 It is now the most commonly performed refractive procedure for low to moderate myopia in the United States. 2 Various complications associated with the procedure, such as abnormal flaps, epithelial ingrowth, diffuse lamellar keratitis, infections, corneal ectasia, dry eyes, nighttime starbursts, and reduced contrast sensitivity, have been described. However, the effects of LASIK on the corneal endothelium are not well known. Most human studies that addressed the effects of LASIK on the corneal endothelium documented the stability of normal corneal endothelium after surgery. 3–5

We report a case of corneal decompensation after LASIK in cornea guttata/Fuchs' endothelial dystrophy.

From the Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.

Submitted September 19, 2002.

Revision received February 4, 2003.

Accepted February 4, 2003.

Address correspondence and reprint requests to Mohammad H. Dastjerdi, M.D., W.K. Kellogg Eye Center, 1000 Wall Street, Ann Arbor, MI 48105. E-mail:

© 2003 Lippincott Williams & Wilkins, Inc.