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Cataract surgery in eyes with Fuchs' dystrophy requires caution
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NEW ORLEANS — Surgeons should exercise extreme caution in performing cataract surgery on patients with Fuchs’ corneal dystrophy, a speaker said here.
“We do see quite a bit of Fuchs’ dystrophy in performing cataract surgery,” Terry Kim, MD, OSN Cornea/External Disease Board Member, said during Cornea Subspecialty Day preceding the American Academy of Ophthalmology meeting.
Kim described four scenarios for cases with Fuchs’ and cataract: cataract being worse, Fuchs’ being worse, both being similarly severe, and both progressing, with anterior stromal haze.
Preoperative slit lamp examination of the cornea, lens and anterior chamber are critical, along with pachymetry and endothelial cell count, Kim said.
Terry Kim
“Anterior chamber depth is very important,” he said.
Kim recommended using a dispersive viscoelastic and adjusting power modulation to minimize stress on anterior chamber structures and the corneal endothelium. A chop technique also reduces trauma. Irrigation and aspiration should be directed away from the endothelium, Kim said.
IOL opacification after Descemet’s stripping endothelial keratoplasty has been associated with hydrophilic acrylic IOLs. Surgeons should implant a hydrophobic acrylic lens to avoid opacity, Kim said.
Postoperative care should include corticosteroids and hyperosmotics, Kim said.
Disclosure: Kim has financial relationships with Alcon and Bausch + Lomb.