Cataract Surgery in Patients with Fuchs’ Corneal Dystrophy-Assessment of Preoperative Pachmetry in Predicting the Relative Risk of Future Penetrating Keratoplasty

Abstract

Abstract: : Purpose: To evaluate the ability of preoperative corneal pachymetry, in patients with Fuchs’ endothelial dystrophy, to predict successful visual rehabilitation as well as the need for future penetrating keratoplasty. Methods: Records of 136 eyes with Fuchs' dystrophy undergoing cataract surgery were reviewed retrospectively. Results: The average follow up time was 21.5 months± 22 months (range, 1 to 94 months). Sixty-five (77.2%) of the patients were female. Fifty-six (41.2%) had some additional ocular comorbidity. The average preoperative BCVA was 20/72 (range, 20/30 – 1/200). The average preoperative pachymetry= 584 ± 39.5 microns (range, 482-674 microns). Fifty eyes (36.8%) had preoperative pachymetry greater than or equal to 600 microns. The average postoperative BCVA was 20/33 (range, 20/15 – 20/ 250). Of the patients with preoperative pachymetry greater than or equal to 600 microns, 5 (10%) progressed to penetrating keratoplasty. Ninety percent of all patients with preoperative corneal thickness greater than 600 microns did not need a corneal transplant within the first year after cataract surgery and had an average postoperative visual acuity of 20/35 (range 20/20- 20/200). Eighty-three percent with corneal thickness greater than or equal to 640 microns did not need a corneal transplant within this same time period, with an average postoperative visual acuity of 20/50 (range 20/20-20/200). Conclusions: To avoid cost and and delay in visual rehabilitation, we suggest that current recommendations to consider an initial triple procedure at preoperative pachymetries greater than 600 microns be expanded. Our data supports the safety of careful cataract surgery in patients with preoperative pachymetries greater than 600 microns. Preoperative pachymetry greater than 640 microns may be a better guideline. This recommendation can be further expanded past 640 microns if less than 20/20 visual acuity is needed.

Keywords: cornea: clinical science • cornea: endothelium