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Surgeon discusses management of cataract and Fuchs' dystrophy
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NEW YORK — Individual case evaluation is important to decide which cataract procedure is beneficial for patients with cataract and Fuchs' dystrophy, according to a speaker here.
“In the decision-making process, do we do nothing and wait, do we do phaco with corneal Fuchs' dystrophy, should we do endothelial keratoplasty alone, or do we do a triple procedure all at the same time — phacoemulsification, endothelial keratoplasty and posterior IOL implantation?” Thomas "TJ" John, MD, asked at OSN New York 2014.
Thomas John
When looking at the corneal endothelium, according to John, function is more important than structure. Structure includes cell count, and function includes symptoms, edema and corneal thickness, John said.
“These factors can enable us as clinicians as to what approach we should take,” John said.
Distribution of endothelial cells is lower in the central cornea compared with the peripheral cornea. Age and trauma are two factors that cause significant endothelial cell loss, he said.
“We want to use procedures that are more endothelial friendly which cause less trauma to the endothelium, use viscoelastic for protection and use the technology that damages the endothelium the least. We may also consider laser-assisted cataract surgery in the present day,” John said.
Endothelial keratoplasty procedures include Descemet's membrane endothelial keratoplasty, Descemet's stripping automated endothelial keratoplasty and pre-Descemet's endothelial keratoplasty.
“The differences between these procedures is that DMEK has no stroma and the other two do contain stroma in your donor disc,” John said.
Disclosure: John has financial interests with Bausch + Lomb, Bio-Tissue, Allergan, Asico and Jaypee-Highlights Medical Publishers.