Elimination of Anterior Corneal Steepening With Descemet Membrane Endothelial Keratoplasty in a Patient With Fuchs Dystrophy and Keratoconus: Implications for IOL Calculation

PURPOSE: To report a case of coexistent Fuchs endothelial corneal dystrophy (FECD) and keratoconus (KCN) in which there was normalization of corneal topography after Descemet membrane endothelial keratoplasty (DMEK). METHODS: Retrospective medical record review. RESULTS: Preoperative findings revealed a best-corrected visual acuity of 20/40 with -1.00 - 2.50 × 147, topographic maximum keratometry of 50.8 D with inferior steeping, and confluent guttae in the left eye. Medical record review revealed myopic shift, but little change in keratometry or corneal thickness over the previous 3 years. The patient developed epithelial edema with contact lens trial, highlighting endothelial dysfunction and eliminating the option of contact lenses for visual rehabilitation. Combined DMEK and cataract extraction with intraocular lens implantation was undertaken. Postoperatively, best-corrected visual acuity was 20/20 with only spherical correction. Elimination of stromal edema led to flattening of maximum anterior keratometry to 46.3 D and reduction of total corneal refractive power (TCRP) by 4.4 D. There was an unanticipated postoperative refractive error of +3.75 D consistent with this normalization of corneal topography. CONCLUSIONS: This is the first case report of the role of DMEK in normalizing corneal topography in coexistent FECD and KCN. The potential impact of DMEK on anterior curvature and TCRP must be considered in intraocular lens power calculation for cataract surgery in patients with FECD and KCN.