PURPOSE: To describe the potential complications of cataract and refractive surgery in patients with Fuchs' endothelial dystrophy (FED) and keratoconus. DESIGN: Retrospective case series. PARTICIPANTS: Eight patients with FED and keratoconus in a large university group practice. METHODS: We reviewed the clinical and topographic findings of 8 patients (15 eyes) with FED and keratoconus. Clinical examination, corneal topography, specular microscopy were done, and sequential central corneal thickness (CCT) was obtained. Follow-up ranged from 1 month to 6 years. MAIN OUTCOME MEASURES: Findings of keratoconus and FED in preoperative evaluation. RESULTS: Five patients had concomitant cataracts; 3 had refractive errors and sought surgical correction. Cataract surgery was performed on 3 of 5 patients (5 eyes). LASIK was performed on one eye of 3 patients. Of 5 eyes that underwent cataract extraction, 4 had blurry vision after surgery. The interval between the surgical procedure and onset of symptoms ranged from 1 month to 4 years. The causes of decreased vision after cataract surgery were corneal edema and/or corneal ectasia. The CCT readings ranged from 426 to 824 microm. One of 4 symptomatic eyes underwent penetrating keratoplasty. The CCTs of 3 patients (6 eyes) who presented with refractive error ranged from 507 to 565 microm. One eye had undergone an attempted LASIK procedure resulting in a lost cap. Corneal topography and specular microscopy showed the coexistence of keratoconus and FED, and the patients were advised against having LASIK surgery. CONCLUSIONS: Corneal thinning caused by keratoconus and concurrent increase in corneal thickness caused by FED may combine to normalize the corneal pachymetry readings; disease severity may be underestimated, which may lead to unexpected postoperative visual outcomes. Routine use of preoperative topography and specular microscopy may help to avert potential surgical complications.

PURPOSE: To report histopathologic findings and treatment of obliterative microangiopathy in a patient with chronic conjunctivitis due to relapsing polychondritis (RP). METHODS: This interventional case report describes a 50-year-old woman with relapsing polychondritis was referred to the Ocular Immunology and Uveitis Service for bilateral tearing due to refractory chronic conjunctivitis. Ocular examination revealed the presence of bilateral follicular conjunctivitis. Conjunctival biopsy of the inferior palpebral conjunctiva was performed, and the histopathologic findings guided the therapeutic intervention. RESULTS: The pathology of the conjunctival biopsy included granulomatous obliterative microangiopathy with numerous eosinophils, plasma cells, lymphocytes, and epithelioid cells in the substantia propia. The chronic conjunctivitis resolved with systemic methotrexate therapy. CONCLUSIONS: Microangiopathy may cause chronic conjunctivitis in patients with RP and may be a harbinger of evolving nonocular problems as a consequence of incomplete control of this autoimmune disorder. Immunomodulatory therapy should be considered in such cases to prevent possible cardiovascular, renal, respiratory, and neurologic complications of vasculitis. Although methotrexate has been used in treatment of RP-related necrotizing scleritis with poor results, it can be sufficient for the conjunctivitis with microangiopathy associated with RP.