Long-term outcome of collagen cross-linking (CXL) for progressive keratoconus with coexistent Fuchs endothelial corneal dystrophy

Corneal endothelial toxicity leading to corneal oedema or endothelial decompensation is a potential concern after corneal collagen cross-linking, especially in patients with susceptible corneas, such as in cases of Fuchs endothelial corneal dystrophy (FECD). A 23-year-old patient diagnosed with keratoconus (KC) was noted to have early-onset FECD with central corneal endothelial guttae in both eyes. Since there was a documented progression, the patient was subjected to corneal collagen cross-linking (CXL) in both eyes. Postoperatively, KC was bilaterally stable post-CXL with no corneal oedema in the postoperative period and no corneal decompensation over a 3-year follow-up period. This case shows that CXL may be safely performed in patients with progressive KC and co-existent FECD when the stromal thickness permits. Our patient did not have corneal decompensation or accelerated loss of endothelial cells for 3 years following CXL.