Resolution of Pseudo Central Island After DSAEK in Patient With Fuchs Endothelial Dystrophy and History of LASIK
Purpose
To present a case report of a patient with Fuchs endothelial dystrophy (FED) and history of myopic laser in-situ keratomileusis (LASIK) who had resolution of a pseudo central island after Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK).
Methods
A 62 year old male with a history of myopic LASIK in both eyes was referred for ghost images in his right eye. Best spectacle corrected visual acuity (BSCVA) was 20/25 in both eyes. Slit lamp examination was significant for corneal guttae and mild corneal edema in both eyes. The LASIK flaps in both eyes did not have any striae and there was no interface haze or fluid. Corneal topography showed a central area of steepening in the right eye and central corneal thickness was 621 microns in the right eye. Initial management for the patient was observation.
Results
The patient then developed a nuclear sclerotic cataract and his BSCVA decreased to 20/50 in his right eye. He underwent a combined phacoemulsification with implantation of an intraocular lens aiming for -1.21 and DSAEK in the right eye. Preoperative axial length was 25.99 mm and keratometry readings were 44.94 and 48.35. Three months after surgery the patient had a hyperopic surprise (spherical equivalent +7.00). Postoperative axial length was 25.83 mm and keratometry readings were 39.15 and 39.52. Corneal topography showed resolution of the central area of steepening. The patient then underwent an intraocular lens exchange in the right eye.
Conclusion
A mild hyperopic surprise is anticipated after DSAEK. The magnitude of the hyperopic surprise and resolution of the area of central steepening in this case was due to the resolution of corneal edema after DSAEK. This case demonstrates the importance of evaluating for FED prior to refractive surgery.