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Protecting endothelium critical in cataract surgery with concurrent Fuchs' dystrophy
SAN FRANCISCO — Cataract surgery alone is preferable to performing it in conjunction with endothelial keratoplasty in cases of concurrent cataract and Fuchs’ endothelial dystrophy, a surgeon said here.
During Cornea Day preceding the American Society of Cataract and Refractive Surgery meeting, Francis S. Mah, MD, presented pearls on protecting the endothelium in cataract surgery with concomitant Fuchs’ dystrophy.
Francis S. Mah
"What are some of the advantages of cataract surgery alone? It is a faster surgery. Endothelial keratoplasty has become much quicker than traditional penetrating keratoplasties, but cataract surgery alone is faster," Mah said. "There’s a faster recovery period for best corrected visual acuity, assuming that the endothelium is not significantly damaged. It is significantly less expensive to do cataract surgery alone. There are fewer postop visits, and there is no need for long-term topical immunosuppression."
Cataract surgery alone is recommended if Fuchs’ dystrophy does not present with corneal edema and the patient is willing to undergo PK if the cornea decompensates after cataract surgery, Mah said.
Mah recommended that corneal incisions be pulled away from the central cornea, as far from the periphery as possible.
Application and reapplication of a dispersive or viscoadaptive viscoelastic will protect the endothelial cells.
A larger continuous curvilinear capsulorrhexis is recommended; hooks or rings will enhance visualization in these cases, Mah said.
Phacoemulsification should be performed in the bag or under the iris plane to divert phaco energy from the endothelium. A lens chopping technique or femtosecond laser lens fragmentation may also be beneficial. The cortex should be removed completely to prevent inflammation. Multifocal IOLs should be avoided in cases with significant or confluent guttae, Mah said.
Frequent use of topical steroids can also protect the endothelium, he said.
Disclosure: Mah has no relevant financial disclosures.