43 EyeWorld Asia-Pacific | December 2024 CORNEA When planning to perform cataract surgery, it’s important to pay particular attention to patients who may have a compromised cornea or endothelial damage. Francis Price Jr., MD, and Zeba A. Syed, MD, spoke with EyeWorld about considerations for cataract surgery in the case of such patient conditions. “We have a lot of patients with already-compromised corneas, and the two biggest groups are those with Fuchs dystrophy and those with previous transplants, penetrating grafts, or endothelial keratoplasties,” Dr. Price said. “We know the cells naturally die off quicker in an eye that’s had a transplant than in a normal eye, so eyes with a previous transplant typically have lower cell counts. We also know that after cataract surgery in general, people lose cells more quickly than they did before they were operated on.” While phacoemulsification techniques have improved significantly, trauma to the corneal endothelium still may occur, Dr. Syed said. This is especially important in patients with preexisting corneal compromise who have a reduced endothelial reserve. Although corneal edema is typically transient after uncomplicated cataract surgery, edema may be chronic with worsening vision. “A common risk factor for compromised corneal endothelium is Fuchs dystrophy, a disorder of guttae formation in Descemet’s membrane and endothelial dysfunction,” Dr. Syed said. The ensuing corneal edema by Ellen Stodola, Editorial Co-Director Cataract Surgery In Eyes With Endothelial Damage results in decreased vision with diurnal variation, and pain may also develop in advanced cases with superficial bullae formation. A study found that among patients with Fuchs who had cataract surgery, approximately 10% eventually underwent endothelial keratoplasty.1 Another risk factor for postoperative corneal edema after cataract surgery presents when a patient has a history of endothelial trauma. Prior glaucoma surgery, including This is an intraoperative photo of an eye with Fuchs dystrophy having simultaneous phaco and DMEK. Note how much clearer the view is on the left side where Descemet’s membrane has been removed, compared with the right side where the view is still obscured by the thickened Descemet’s membrane and guttae. Source: Francis Price Jr., MD
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