Fuch's Dystrophy is a relative contraindication to lasik but if it is performed, does the rate of progression of the dystrophy accelerate?
In LASIK corneal nerve fibers are cut, which have impact on corneal nutrition, therefore predisposing to progress of Fuch's dystrophy
Most refractive surgeons feel that LASIK is a contraindication to LASIK and would not perform this procedure on patients with a known Fuchs' dystrophy or guttae for that matter. PRK is more of a relative contraindication and might be considered as an alternative in corneas of normal thickness. The reason why PRK would be considered instead is the fact that a flap is not formed in this procedure - the flap formed in LASIK could be potentially compromised with the decreased endothelial pumping in Fuchs'
There have been reports of corneal decompensation after LASIK in fuchs' dystrophy. (Ref: Cornea. 2003 May;22(4):379-81.)
If it's confirmed case of Fuchs' dystrophy before surgery, LASIK is best avoided.
Fuchs' Dystrophy is a contraindication for incision-based refractive surgery techniques, such as AK, RK, conventional or custom wavefront Lasik, and Bladeless Lasik. It is an absolute contraindication for P-IOLs, which are known to cause endothelial cell loss.
Surface ablation techniques such as PRK, LASEK, and Epi-Lasik "may" be appropriate in some circumstances, however advanced Fuch's Dystrophy would be a contraindication for these procedures as well.
Fuch's Dystrophy is not necessarily a contraindication for RLE. RLE is exactly the same as cataract surgery, and cataracts are directly related to Fuch's Dystrophy about 15% of the time.
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