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
