Cataract Surgery In Fuchs Endothelial Corneal Dystrophy: Wait And See

To evaluate clinical outcomes, visual rehabilitation, and the rate of corneal decompensation after isolated phacoemulsification with posterior chamber intraocular lens implantation in patients with Fuchs endothelial corneal dystrophy.

Department of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkiye.

Patients with FECD grade ≥2 (>1 mm of confluent central corneal guttae) were included. Cataract density was graded using the Lens Opacities Classification System III. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp findings, central corneal thickness (CCT), and endothelial cell density (ECD) were recorded pre- and at 1, 2, and 6 months post-operatively. Post-operative changes in BCVA, CCT, and ECD, as well as the rates of corneal decompensation and endothelial keratoplasty (EK), were assessed. All surgeries were performed by a single experienced surgeon using balanced salt solution and a dispersive ophthalmic viscosurgical device (sodium hyaluronate–chondroitin sulfate).

A total of 37 patients and 57 eyes were included; the mean age was 68.98 ± 10.04 (39-91), and the male-female ratio was 30/7. Nuclear cataract grading (n=55) was: Grades 1–6 were 3 (5.4%), 9 (16.4%), 19 (34.5%), 14 (25.5%), 6 (10.9%), and 4 (7.3%), respectively. The mean pre-operative BCVA was 0.34±0.19 (0.001-0.7) and 0.68±0.30 (0.05-1) at 1 month post-operatively (p<0.001). At 2 and 6 months post-operatively, the values were 0.66±0.28 (0.05-1) and 0.73±0.22 (0.16-1), respectively. Mean pre-operative CCT was 575.89±56.73  and 609.63±49.47 microns at 1 month post-operatively (p=0.02). All except 2 eyes (3.5%) (with persistent edema despite medical therapy underwent EK during follow-up) resolved with no corneal edema at the last visit.

Patients with FECD, who often present with triple procedures or early post-operative EK, constitute a special group in cataract surgery. However, with appropriate peri-operative protection, post-operative management, and sufficient time, these cases can recover, thereby avoiding unnecessary medical and financial burdens in visual rehabilitation.