Clinical outcomes of cataract surgery in patients with early Fuchs' corneal endothelial dystrophy

Session Details

Session Title: Cataract Surgery Special Cases

Session Date/Time: Monday 09/10/2017 | 14:30-16:00

Paper Time: 14:54

Venue: Meeting Center Room I

First Author: : O.Antonova RUSSIA

Co Author(s): :    B. Malyugin   E. Malyutina                 

Abstract Details

Purpose:

To evaluate the clinical outcomes of cataract surgery in patients with Fuchs' endothelial corneal dystrophy (FECD).

Setting:

S. Fyodorov Eye Microsurgery Institution, Moscow, Russia.

Methods:

23 patients (23 eyes) with cataract and Fuchs' endothelial corneal dystrophy (endothelial stage: cornea guttata without corneal oedema) underwent phacoemulsification with IOL implantation. Mean nucleus density was 2,86±0,73. Stellaris system (Bausсh&Lomb) was used in all cases, followed by hydrophibic acrylic IOL in-the-bag implantation. Special attention was on to endothelial protection including the use of combination of dispersive (Viscoat, Alcon) and cohesive (Provisc, Alcon) ophthalmic viscosurgical devices. Best-corrected visual acuity (BCVA), endothelial cell density (ECD), central corneal pachymetry (CCP) and postoperative complications were evaluated before and 1, 3, 6, 12 and 24 months after the surgery.

Results:

Preoperative BCVA 0,27±0,13, ECD 993±155 cells/sq.mm, CCP 568±55 μm. No complications were observed during the surgeries. The average APT, EPT 26.93+1,12, 04,97+0,09 sec respectively. Early postop transitory corneal oedema - 4 cases (17,3%). Late postop complications included 2 cases (8,3%) of persistent corneal oedema requiring endothelial keratoplasty. 1 month postop BCVA 0,7±0,12, ECD 802±104 cells/sq.mm, CCP 573±27μm. At 12 month after the surgery BCVA 0,7±0,21; ECD 765±191 cells/sq.mm, CCP 575±21μm. At 24 months postop BCVA was 0,8±0,11, ECD 745±162 cells/sq.mm, CCP 561±26μm. Endothelial cell loss of at 1, 12 and 24 months postop was 19,2±1,14%, 22,9±0,71%, 24.9±0,58% respectively.

Conclusions:

Cataract surgery in patients with early FECD allowed for rapid visual rehabilitation. However relatively high endothelial cell loss up to 2 years postop was observed in spite of the use of state-of-the art equipment, IOLs and OVDs. This loss was significantly exceeding the numbers after uncomplicated age-related cataract surgery presented in the literature. To our opinion unhealthy status of the corneal endothelium make it specifically vulnerable to intraoperative trauma that carries the risk of corneal decompensating in the long-term. We believe that this category of patients require dynamic ECD control in the long-term postoperative period.

Financial Disclosure:

NONE