Corneal flattening after simultaneous DMEK and phacoemulsification in patient with Fuchs endothelial dystrophy, keratoconus and cataract combined

Abstract This is a case report of a patient with concomitant Keratoconus (KC), Fuchs Endothelial Dystrophy (FED) and cataract with corneal decompensation submitted to Posterior Lamellar Corneal surgery (Descemet’s Membrane Endothelial Keratoplasty - DMEK) associated with phacoemulsification with intraocular lens (IOL) implantation. Corneal flattening and uncorrected visual acuity of 20/25 was observed in the postoperative period. We reasure the viability of DMEK as an alternative to Penetrating Keratoplasty (PK) in cases of associated DEF and KC associated. Changes in corneal curvature may occur in this group of patients and lead to the possibility of refractive unpredictability in IOL calculation when performing a combined cataract surgery. Despite unexpected corneal flattening, satisfactory final visual acuity was achieved, demonstrating the possibility of success of this approach in the coexistence of the three conditions. Nonetheless, the possibility of corneal curvature changes should be considered in patients with KC and corneal decompensation due to FED in decision making, regarding simultaneous or sequential surgical approach.

摘要 本病例报告报道了1例同时罹患圆锥角膜（Keratoconus, KC）、富克斯角膜内皮营养不良（Fuchs Endothelial Dystrophy, FED）及白内障伴角膜失代偿的患者，该患者接受了后板层角膜手术——后弹力层内皮角膜移植术（Descemet’s Membrane Endothelial Keratoplasty, DMEK）联合超声乳化白内障吸除术与人工晶状体（IOL）植入术。术后随访观察到角膜变平，且裸眼视力达到20/25。本研究证实，对于合并FED与KC的病例，DMEK可作为穿透性角膜移植术（Penetrating Keratoplasty, PK）的替代方案，具备临床可行性。此类患者群体可能出现角膜曲率改变，进而导致联合白内障手术时人工晶状体度数计算存在屈光预测不确定性。尽管出现了意料之外的角膜变平，最终仍获得了满意的术后视力，证明该手术方案在三种疾病共存的情况下可取得成功。不过，在为KC合并FED所致角膜失代偿患者制定同期或分期手术方案时，应考虑到角膜曲率发生改变的可能性。