Which statement is true regarding endothelial keratoplasty (EK) in relation to Downs syndrome and prior LASIK?

• A. Downs syndrome and prior LASIK are contraindications for EK
• B. Downs syndrome and prior LASIK can be used for EK only
• C. EK never used for Downs syndrome
• D. LASIK disqualifies EK

Answer: (B)

Endothelial keratoplasty targets the posterior part of the cornea, replacing only the dysfunctional endothelium while leaving the rest of the cornea intact. Neither Down syndrome nor a history of LASIK by itself prevents EK—the procedure can be performed in eyes with Down syndrome and in eyes that have had prior LASIK. The LASIK alterations are in the anterior cornea, but the graft sits on Descemet’s membrane at the back, so the surgery can still be successfully done with appropriate planning and technique. In short, these conditions are not absolute contraindications; EK remains a viable option when endothelial failure necessitates treatment.