Cataract surgery with corneal endothelial pathology.

Area of Science:

• Ophthalmology
• Corneal Surgery
• Cataract Surgery

Background:

• Fuch's endothelial corneal dystrophy (FECD) frequently co-exists with cataracts, presenting surgical decision challenges.
• Descemet's membrane endothelial keratoplasty (DMEK) is the preferred endothelial keratoplasty for FECD, offering superior visual outcomes compared to DSEK and penetrating keratoplasty.
• Traditional decision-making relied on cell count and pachymetry; advanced imaging now aids prognostication for cataract surgery alone.

Purpose of the Study:

• To review the advantages and disadvantages of simultaneous versus staged surgical approaches for FECD patients with cataracts.
• To provide guidance on decision-making for combined corneal and cataract surgery in FECD.
• To discuss the evolving use of premium intraocular lenses (IOLs) in these cases.

Main Methods:

• Literature review comparing simultaneous triple DMEK with staged DMEK and cataract surgery.
• Analysis of visual outcomes, refractive predictability, and graft-related complications.
• Discussion of factors influencing IOL selection, including premium IOLs and extended depth of focus lenses.

Main Results:

• Staged surgery, particularly DMEK followed by cataract surgery, yields better visual outcomes due to more accurate intraocular lens power calculation post-keratoplasty.
• Graft detachment and rebubbling rates are comparable between triple DMEK and staged procedures.
• Patient demand for spectacle independence favors a staged approach, with increasing use of premium IOLs.

Conclusions:

• A staged surgical approach is increasingly preferred for FECD patients with cataracts to achieve optimal visual outcomes and spectacle independence.
• Careful consideration of refractive changes post-keratoplasty is crucial for accurate IOL power calculation.
• The use of premium IOLs, especially extended depth of focus lenses, is becoming more common in managing these complex cases.