Bilateral coexistence of keratoconus and macular corneal dystrophy

Bilateral coexistence of keratoconus and macular corneal dystrophy is a very rare clinical entity. Further elaboration on the possible genetic, histopathologic, pathophysiologic and biochemical correlation is required to study the nature of the condition. The authors hereby report a 21-year-old female who presented with the typical signs and topographic evidence of keratoconus in association with macular corneal dystrophy. Histopathologic evaluation from the excised corneal button after corneal transplant confirmed the diagnosis. To our knowledge, there is only one previous report in the literature linking the association of keratoconus and macular corneal dystrophy in the same eye bilaterally

Corneal decompensation after Phacoemulsification in Fuchs endothelial dystrophy

To evaluate the efficacy of performing phacoemulsification in patients with endothelial dysfunction and the risk of subsequent corneal decompensation. A retrospective design was employed on 21 patients [21 eyes] diagnosed as endothelial dystrophy based on clinical signs and pachymetry readings. Patients were divided into three groups based on corneal thicknesses: < 600 micro m, between 600-650 micro lm and > 650 micro m, respectively. None of our patients had clinical signs of corneal epithelial edema preoperatively Patients with corneal thickness greater than 600 micro m were added to our penetrating keratoplasty waiting list as a precaution and warned about the risk of possible corneal decompensation. Outcome measures evaluated were pre- and postoperative visual acuity, pre- and postoperative corneal thickness measurement using ultrasonic pachymetry, phaco time and power used intraoperatively, and follow-up duration and patient satisfaction. A modified phaco technique was used in order to avoid corneal decompensation and minimize possible endothelial injury. The range of preoperative visual acuity was between counting fingers and 20/50 with a median of 20/80-207 100. Postoperative visual acuity range was between 20/25-20/50 with a median of 20/30. Preoperative corneal thickness was 12 eyes less than 600 micro m, seven eyes between 600-650 micro m, and two eyes greater than 650 micro m. All eyes remained within the same range of corneal thickness postoperatively. Average phaco time was 2.2 minutes [range, 1-3 minutes]. All cases were operated by the same surgeon using ALCON Legacy phacoemulsification machine. Average phaco power was 26% [range, 16-36%]. Patients were followed for an average of 26 weeks [range, 6-88 weeks] with no clinical signs or pachymetry readings suggestive of corneal decompensation or worsening. Patient satisfaction was reported based on a verbal questionnaire. Most patients reported moderate to significant improvement postoperatively. A modified phaco technique without PKP is successful in patients with corneal thickness greater than 600 micro m. Pachymetry is a reliable estimate of the endothelial function. Phacoemulsification without PKP may result in significant visual acuity improvement and patient satisfaction in Fuchs' endothelial dystrophy even with corneal thickness greater than 600 micro m. We had no postoperative corneal decompensation during the follow-up period