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Klin Monbl Augenheilkd 2022; 239(06): 767-774
DOI: 10.1055/a-1756-5199
Übersicht

Cataract Surgeries in Patients with Fuchs Endothelial Dystrophy

Article in several languages: deutsch | English
Philip Christian Maier
Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
,
Thomas Reinhard
Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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Abstract

Patients with Fuchs endothelial dystrophy often develop visual symptoms between 50 – 60 years of age, which is the same time that the first symptoms of a developing cataract start to appear. On the other hand, in patients with a clinically significant cataract, corneal guttata may be detected by chance during a routine clinical workup. In both situations, the surgeon has to decide whether DMEK or cataract surgery should be performed alone or in combination. In the case of advanced Fuchs dystrophy with or without a clinically significant cataract, a combined surgery known as the triple procedure seems favorable as the clinical course after this procedure is the same as following sequential surgery. Furthermore, the affected patients will only have to undergo one surgery and will reach the final visual acuity much faster. Posterior lamellar keratoplasty alone can only be an option in the case of young patients with advanced Fuchs dystrophy, intact accommodation, and no signs of cataract. In the case of a clinically significant cataract combined with corneal guttata, clinical features including central corneal thickness and endothelial cell density, among others, can help to decide which surgical procedure seems to be the best. In case of cataract surgery alone, the surgeon needs to protect the corneal endothelium as well as possible. The softshell technique can help to reduce the loss of endothelial cells during cataract surgery, whereas femtosecond laser assisted cataract surgery is still controversial. The following review will discuss the most important preoperative, perioperative, and postoperative factors that need be considered in order to achieve the best result for our patients.

Key words

Fuchs endothelial dystrophy - cornea - cataract - DMEK


Publication History

Received: 14 December 2021

Accepted: 27 January 2022

Article published online:
14 April 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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