Cataract Surgery In Patients With Significant Corneal Opacities, Epithelial And Epitheliostromal Corneal Dystrophies

To present a series of cases illustrating our approach to overcoming both preoperative and intraoperative challenges in cataract surgery for patients with significant corneal opacities, or various degrees of epithelial or epitheliostromal dystrophies. We emphasize tailored preoperative assessments, individualized intraocular lens (IOL) selection guided by biometric and topographic analyses, and customized postoperative management to optimize refractive outcomes and enhance patient satisfaction.

Clinical Emergency Eye Hospital Bucharest

All patients have undergone cataract surgery with IOL implantation with prior documentation of the extent of the corneal implication: slit-lamp exam, anterior segment optical coherence tomography, biometry. The degree and localisation of the corneal opacities have guided our unique surgical approach in each of the presented cases.

The first two cases presented a moderate degree of corneal involvement, the patients suffering from epithelial basement membrane dystrophy, Reis-Buckler dystrophy respectively, causing irregular astigmatism. Biometric studies, correlated with topography aspects, guided our choice of intraocular lens for optimal refractive outcomes and patient satisfaction. Biometric studies were more important in patients with severe epitheliostromal dystrophies that benefitted of phototherapeutic keratectomy or DALK  prior to cataract surgery. Refractive intraocular lens choices mirrored the complexity of this case, with a target refraction meant to compensate for the post surgical  corneal changes.

Careful preoperative assessment of such complex cases and considering the full spectrum of options, such as scleral lenses, are key to obtaining the best possible visual acuity gains even in the cases that are complicated by corneal diseases.