Bilateral Fuchs’ Superficial Marginal Keratitis Diagnosis and Treatment

In this study, we reported two patients with clinical pictures compatible with the diagnosis of bilateral Fuchs' superficial marginal keratitis (FSMK) treated with surgical treatment and anti-inflammatory drugs. The cases suffered from bilateral photophopia, blurred vision, and pseudopterygium with normal intraocular pressure (IOP). Pseudopterygia extended from temporal and nasal sides and had a gray line between the corneal normal epithelium with no lipid deposits. The first case had a bilateral high mixed astigmatic error and the second had dry eye symptoms. No abnormalities, including systemic inflammatory disease, were found in the laboratory investigations. The first case had bilateral pseudopterygium excision, mitomycin C (MMC) application, and pedicled conjunctival flap transplantation. The patient was followed regularly, and her condition was stable without any recurrence or deterioration in the ocular findings. The second case had conjunctival resection + amniotic membrane transplantation + MMC application six times on the right eye and three times on the left eye during 4 years and suffered recurrences after each operation. Her visual acuity severely decreased with the elevated IOP of both eyes. The patient refused to do any further surgical intervention. Despite its rarity, FSMK should be considered when peripheral corneal infiltration, corneal thinning, and pseudopterygia are observed in both eyes.