Fuchs; dystrophy: cataract surgery or corneal transplantation

A diagnosis of Fuchs’ dystrophy inevitably leads to some anxiety. Fuchs’ is a condition that progresses and gradually leads to deterioration in vision due to waterlogging of the cornea.

Fuchs’ dystrophy is a diagnosis that is typically made in patients over 50, although younger people may also be diagnosed. As patients are older at the time of diagnosis there may also be cataract present. So, should patients have cataract surgery alone with a transplant some time later, or should they have a combined cataract operation and corneal transplant?

The time to have any surgery is if the cataract or Fuchs’ dystrophy is affecting your vision and lifestyle. Any intraocular surgery such as cataract surgery will further reduce the number of endothelial corneal cells in a patient with Fuchs’ dystrophy. If the Fuchs’ dystrophy is still in its early stages and there is sufficient endothelial cell reserve, the patient can proceed with cataract surgery alone. The operating surgeon should use a modified ‘soft shell’ technique during cataract surgery to minimise damage to remaining endothelial cells. An endothelial cell scan should be part of the pre-operative assessment and will inform the surgeon of whether cataract surgery alone without corneal transplantation can be attempted.

Patients who have a low endothelial cell count and who have diurnal changes in their vision and evidence of corneal swelling are likely to be worse after cataract surgery alone. These patients should have combined cataract surgery and corneal transplantation. Alternatively, some surgeons may wish to separate the cataract surgery from the transplant and perform the latter a month or so later. Our preference is to combine the two procedures.

Understanding Fuchs Dystrophy | Cataract Surgery or Corneal Transplantation?

Mr Romesh Angunawela

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Understanding Fuchs Dystrophy | Cataract Surgery or Corneal Transplantation?

Mr Romesh Angunawela

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