ESCRS - POCOR316 - Keratoconus Vs. Pseudokeratoconus In Fuchs’ Endothelial Corneal Dystrophy: Diagnostic And Therapeutic Dilemma

Keratoconus Vs. Pseudokeratoconus In Fuchs’ Endothelial Corneal Dystrophy: Diagnostic And Therapeutic Dilemma

Published 2026 - 44th Congress of the ESCRS

Reference: POCOR316 | Type: Free paper | DOI: 10.82333/h586-2e15

Authors: Dr Mostafa Aghi* 1 , Dr Hosam Dandachli 1 , Prof. Dr Daniel Meller 1

1Ophthalmology Department,University of Jena,Jena,Germany

Purpose

The differential diagnosis between keratoconus and pseudokeratoconus in patients with suspected keratoconus and concomitant Fuchs’ endothelial corneal dystrophy (FECD) represents a clinical challenge. This case series of five patients evaluates diagnostic and therapeutic approaches to facilitate differentiation between these entities and to define the optimal treatment strategy.

Setting

a case serie of 5 patients with concomitant suspect of keratoconus and fuchs endothlial dystrophy, seen at a tertriary hospital

Methods

Five patients with suspected keratoconus and FECD were analyzed. Diagnostic workup included corneal tomography, as well as clinical and biometric examinations. Two patients underwent Descemet membrane endothelial keratoplasty (DMEK).

Results

  • Cases 1 and 2: Corneal tomography demonstrated clear patterns consistent with pseudokeratoconus secondary to FECD. The findings seemed reliable to differentiate this cases from true keratoconus.

  • Case 3: Corneal tomography was inconclusive, and definitive differentiation between keratoconus and pseudokeratoconus was not possible.

  • Case 4: Tomographic findings were likewise inconclusive. Following DMEK, the corneal changes regressed, confirming the diagnosis of pseudokeratoconus.

  • Case 5: This case illustrates the challenges of biometry and intraocular lens (IOL) calculation in a planned triple-DMEK procedure. Due to bilateral bullous keratopathy, reliable biometry was only possible after corneal epithelial debridement.

Conclusions

This case series highlights the diagnostic dilemma in patients with suspected keratoconus and coexisting FECD and presents cases in which definitive diagnosis was only achievable after DMEK.