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Descemet Stripping Endothelial Keratoplasty for the Treatment of Combined Fuchs Corneal Endothelial Dystrophy and Keratoconus

Vira, Samir MD; Abugo, Usiwoma MD; Shih, Carolyn Y. MD, MBA, MPH; Udell, Ira J. MD; Sperling, Brian; Hannush, Sadeer B. MD; Basti, Surendra MD; Bouchard, Charles S. MD

doi: 10.1097/ICO.0b013e3182a7389c
Clinical Science

Purpose: To report the first case series of patients with Fuchs corneal endothelial dystrophy (FCD) and keratoconus (KCN) who underwent Descemet stripping endothelial keratoplasty (DSEK).

Methods: This is a retrospective case series of 6 eyes of 4 patients with combined FCD and KCN who underwent DSEK at 3 different centers. Clinical information collected included corneal topography measurements, central corneal thickness, and endothelial cell count. Visual outcomes and change in keratometric measurements were evaluated.

Results: The follow-up for patients ranged from 10 to 72 months. The best-corrected visual acuity was 20/40 or better in all 6 eyes. The mean keratometric measurements decreased in all cases (range of 0.5–5.8 diopters); however, topography still demonstrated an inferior steepening in each case.

Conclusions: Patients with FCD and KCN have been previously reported as being managed with penetrating keratoplasty. We present 6 eyes of 4 patients who were managed with DSEK for the FCD. Topographically, the characteristic inferior steepening of KCN did not change; however, all patients with DSEK had flatter postoperative keratometric measurements with improved visual acuity. If a DSEK is performed for FCD before apical corneal scarring from KCN, a good visual outcome may be achieved.

*Department of Ophthalmology, Loyola University Medical Center, Maywood, IL;

Department of Ophthalmology, North Shore Long Island Jewish Health System, Bronx, NY;

Albert Einstein College of Medicine, Bronx, NY;

§Cornea Service, Wills Eye Institute, Philadelphia, PA; and

Department of Ophthalmology, Northwestern Memorial Hospital, Chicago, IL.

Reprints: Samir Vira, Department of Ophthalmology, Loyola University Medical Center, 2160 South 1st Avenue, Suite 2601, Maywood, IL 60153 (e-mail:

Author Disclosure Information and Conflicts of Interest: S. Vira, None; U. Abugo None; B. Sperling, None; S.B. Hannush, None; S. Basti, None; C.S. Bouchard CS, None.

Received April 30, 2013

Accepted July 27, 2013

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.