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Endothelial decompensation after laser in situ keratomileusis
David T Vroman1, Kerry D Solomon, Mike P Holzer
1Magill Research Center for Vision Correction, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina 29425, USA. vrocornea@hotmail.com
Journal of Cataract and Refractive Surgery
|November 30, 2002
Summary
Laser in situ keratomileusis (LASIK) surgery resulted in corneal decompensation in a patient with Fuchs
Area of Science:
- Ophthalmology
- Corneal Surgery
- Refractive Surgery
Background:
- Laser in situ keratomileusis (LASIK) is a common refractive surgical procedure.
- Corneal guttata and Fuchs' dystrophy are conditions affecting corneal endothelium.
- The safety and efficacy of LASIK in eyes with pre-existing endothelial conditions require careful consideration.
Observation:
- A 58-year-old woman with pre-existing corneal guttata and Fuchs' dystrophy underwent LASIK surgery.
- The patient had differing preoperative pachymetry measurements between her right (586 microm) and left (656 microm) eyes.
- The LASIK treatment targeted +1.50 diopters in the right eye and +3.25 diopters in the left eye.
Findings:
- Postoperative edema in the right eye resolved, with pachymetry returning to near baseline (585 microm).
- However, the left cornea decompensated significantly, reaching a final pachymetry of 779 microm, despite maximal medical management.
- This necessitated a referral for penetrating keratoplasty 14 months post-LASIK.
Implications:
- LASIK may pose risks for patients with pre-existing corneal conditions like guttata and Fuchs' dystrophy.
- Careful preoperative assessment of corneal thickness and health is crucial before considering refractive surgery.
- Corneal decompensation following LASIK in susceptible individuals may require advanced surgical interventions like corneal transplantation.