LASIK and Fuchs Endothelial Corneal Dystrophy

Many patients with Fuchs Endothelial Corneal Dystrophy (FECD), including members of Fuchs Friends, seek refractive surgery such as LASIK ¹ but wonder about its safety in the setting of their disease. This question has been studied, and published literature reveals a strong consensus that, among patients who have not undergone surgery for FECD,²  LASIK can cause more rapid progression of the disease and is not recommended. ^3,4

In contrast, in patients who have undergone transplant for FECD, evidence appears to suggest that LASIK is well-tolerated,^5,6 although such patients should be properly screened to minimize potential complications.⁷ What remains uncertain is the question of whether patients who have had previous LASIK can safely undergo subsequent surgery for FECD (e.g., DMEK, DSO). This becomes an important consideration given that, although DMEK grafts are considered durable, there are uncommon but identifiable circumstances in which they may require replacement (e.g., end of natural lifespan, early graft failure, rejection). Similarly, patients undergoing DSO, considered an emerging technique, are informed that, in the event of failure or patient dissatisfaction with the outcome, vision can be salvaged by subsequent DMEK.

Available published data do not address the issue of whether DMEK can be safely and effectively performed in patients with prior LASIK. However, one well-respected cornea expert has indicated that such a procedure would be possible, but not until after at least one year following LASIK, to ensure sufficient healing, and only in patients whose corneas meet appropriate screening criteria.

For these reasons, patients with FECD who have not had surgery should avoid LASIK, and those desiring LASIK after surgery for FECD should seek the advice of their cornea surgeon.

References

1. Technically “Laser-assisted in situ keratomileusis.”
2. Such procedures include partial corneal transplant, such as DMEK (the current gold standard) and DSO, which does not involve transplanted donor tissue.
3. Moshirfar M et al. Laser In Situ Keratomileusis (LASIK). In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2024. Available at: http://www.ncbi.nlm.nih.gov/books/NBK555970/. Accessed August 19, 2024.
4. Woreta FA et al. LASIK and surface ablation in corneal dystrophies. Surv Ophthalmol 2015;60:115–22.
5.  Moshirfar M et al. LASIK Surgery After Corneal Transplant. Available at: https://eyewiki.org/LASIK_Surgery_After_Corneal_Transplant.
6. Ratanasit A, Gorovoy MS. Laser-assisted in situ keratomileusis or photorefractive keratectomy after descemet stripping automated endothelial keratoplasty. Cornea 2011;30:787–9.
7. Cornea Research Foundation of America – Can I have LASIK after DMEK? Available at:
   https://www.cornea.org/Cornea-Blog/April-2017/Can-I-have-LASIK-after-DMEK.aspx. Accessed August 19,2024