К вопросу о коморбидности кератоконуса и первичной эндотелиальной дистрофии роговицы Фукса (клинические случаи)

Abstract

Purpose. To describe the clinical cases and surgery results in patients with concomitant of keratoconus and Fuchs' corneal endothelial dystrophy. Material and methods. Retrospective analysis of 3 patients using different surgical techniques. All patients were female, they underwent diagnostic procedures including: keratotopography, optical coherence tomography of the anterior segment of the eye, Scheimpflug keratotomography, endothelial microscopy. First patient underwent penetrating keratoplasty (PKP), the second one – descemet stripping automated endothelial keratoplasty (DSEK), and the third one – descemet membrane endothelial keratoplasty (DMEK). Results. In all cases the combination of keratoconus and fuchs endothelial corneal dystrophy occurred in one eye, while cornea guttata was observed in both eyes. The diagnosis of keratoconus was complicated by the presence of corneal edema due to endothelial dysfunction. As a result, visual rehabilitation was achieved in 2 patients after PKP and DSEK, and in the third case (DMEK), the presence of pronounced opacities of the stroma in the central zone did not result in increase of visual acuity, despite the good function of the graft endothelium, which required the PKP. Conclusion. Surgical tactics should be based primary on the replacement of the pathologically altered endothelial monolayer (DSEK, DMEK). As for the simultaneous replacement of the corneal stroma (PKP), the decision is based on the progression of keratoconus, the degree of corneal thinning, and the presence of its surface irregularity. Key words: Fuchs' endothelial corneal dystrophy, keratoconus, endothelial keratoplasty, penetrating keratoplasty, Descemet's membrane endothelial keratoplasty, corneal endothelium