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Surgeon: Sick, fragile corneas should hasten cataract surgery
COSTA DO SAUIPE, Brazil — Patients with sick or fragile corneas should not have cataract surgery delayed, advised Paulo Cesar Fontes, MD.
Dr. Fontes said sick corneas would include those with progressive endothelial dystrophy, for example, which will continue to lose epithelium. Fragile or weak corneas might be the result of a corneal transplant, for instance, he explained.
Dr. Fontes cited as an example the case of a patient with cataract who has cornea guttata. Specular microscopy shows an endothelial density of 700-800 cells/mm2. The patient has 20/80 to 20/100 vision, but the surgeon does not want to operate because the patient may need a corneal transplant later.
“The result is that the cornea guttata continues to develop and the cataract becomes harder and harder, and that is the worst of all combinations,” Dr. Fontes said here during the Brazilian Congress on Cataract and Refractive Surgery.
Deciding whether or not to operate involves knowing the endothelial health and the status of central cell counts vs. peripheral cell counts, he added.
“The (cataract) incision should be done where there are fewer cells, so that cell loss is reduced,” Dr. Fontes said.
When central pachymetry is equal to or lower than the average peripheral count, he said, surgery can be done.
“Once you decide to do the surgery, it is vital to protect the endothelium with a cohesive viscoelastic, perhaps using the Arshinoff technique,” Dr. Fontes said. In extreme cases, he said, it is less traumatic to the eye to introduce another lens, doing a secondary piggyback.
“We have a solution for almost any situation,” Dr. Fontes said. “Some are better than others. If my patients have cornea guttata and low central cell count and start developing a cataract, the better solution is early cataract surgery, since the cornea certainly will become progressively weaker.”