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So you have Fuchs’ endothelial corneal dystrophy and your eye doctor has said it is time for cataract surgery. Don’t panic! Here are some helpful tips and suggestions to maximize your chance of happy vision afterward.
Consider an opinion with a cornea specialist.
There are many exciting, new treatment options for Fuchs’ Dystrophy today that can be combined or staged with your cataract surgery such as a Descemet’s Stripping Only or a Descemet’s Membrane Endothelial Keratoplasty. While some patients can benefit from cataract surgery alone, others may achieve better results with a combination surgery. Often a careful clinical exam with an up-to-date cornea specialist is needed to determine what procedure or combination of procedures is right for you.
Pre-treat your eye with hypertonic salt eye drops or ointments
Using Muro 128 eye drops or eye ointment prior to your procedure can help reduce any pre-existing cornea swelling and maximize the speed of your vision recovery after surgery. Almost every cornea swells some after cataract surgery, so it is a good idea to reduce as much of that swelling ahead of time as possible.
Consider having Femtosecond Laser Assisted Cataract Surgery (FLACS)
A study in the Journal of Cataract & Refractive Surgery from July 2018 by Fan, Wei et. al. compared conventional cataract surgery to Femtosecond laser-assisted cataract surgery for Fuchs’ Dystrophy patients. They found that the femtosecond laser surgery patients needed less energy to remove the cataract and had less endothelial cell loss afterward. They also found that while both groups had swelling in the cornea after surgery, the FLACS group had less swelling compared to the standard cataract surgery group. These findings suggest that FLACS can reduce the risk of persistent corneal edema or needing additional surgery afterward for Fuchs’ patients.
Of note, FLACS is not covered by insurance which means there is an out of pocket expense associated with choosing this option.
Have realistic expectations
While the options for cataract surgery have advanced tremendously and there are many terrific refractive options today, not every patient is a good candidate for these technologies. Fuchs’ dystrophy can be a progressive disease for many patients which means that the shape and power of your cornea will change over time, especially if you go on to need additional cornea procedures. For these reasons, a standard monofocal intraocular lens implant may be a good option. These lenses have extremely high quality optics but they do not correct astigmatism or provide a range of vision. As such, it is important to have a realistic expectation that you may need glasses after surgery for your best vision.
If you desire glasses independence, here are some options
If glasses independence is important and you have significant Fuchs’ dystrophy, then you could consider treating both the cornea and cataract together. This would involve replacing the nonfunctional corneal cells in a surgery called DMEK or DSAEK. By combining the cornea surgery and the cataract, you could minimize dependence on glasses by choosing a Light Adjustable Lens Implant. The light adjustable lens allows for fine tuning of the vision after the cornea has recovered, giving you the best chance great vision without glasses. Another option is you could choose to have the cornea surgery first and then have a custom cataract surgery later with a fixed lens implant. Be sure to discuss your options and your goals with your cataract surgery and know your options ahead of time.
Expect your vision may take a few days or weeks to clear
Be patient after your cataract surgery. Patients with Fuchs’ corneal dystrophy may take a little longer to recover the vision than others after cataract surgery. If your vision hasn’t cleared and a few weeks have passed, then return to your eye surgeon for a follow up to discuss your options and for a referral to a cornea specialist.
For more information about Fuchs’ Dystrophy click https://tailoredeyes.com/eye-conditions/fuchs-dystrophy/
I’m Dr. Kane, and that’s my take on it.
At Tailored Eyes, we will perform a thorough evaluation of your eyes and together formulate a customized treatment plan to meet your vision needs.
Steven Kane, MD, FAAO is a Cornea, Cataract, and Refractive Surgery specialist with Tailored Eyes in Sarasota county Florida. He proudly serves the people of Venice, South Venice, Sarasota, Plantation, Osprey, Nokomis, Laurel, Siesta Key, Casey Key, Bradenton, Lakewood Ranch, Anna Maria, Palmetto, Ellenton, St. Petersburg, Englewood, North Port, Punta Gorda, Port Charlotte, Charlotte Harbor, Manasota Key, Arcadia, Fort Myers and Cape Coral.