OPHTHALMOLOGY

Q: Can I still have cataract surgery even though I have mild Fuchs’ dystrophy?

A: Fuchs’ dystrophy is an eye disease in which the innermost layer of cells in the cornea experience degenerative changes. This cell layer, called the endothelium, is responsible for maintaining the proper amount of fluid in the cornea. When the endothelial cells deteriorate, fluid starts to build up in the cornea causing corneal swelling and gradual thickening. The more advanced the Fuchs’ dystrophy, the blurrier and more indistinct the vision due to more corneal edema. Fuchs’ is a slowly progressive, hereditary disease that may or may not ever become symptomatic. Symptoms, should they occur, usually become more noticeable after age 50.

Fuchs’ dystrophy may also be associated with cataracts. People suffering from Fuchs’ are at risk of developing cataracts as their dystrophy worsens. There is a risk that performing cataract surgery can worsen the Fuchs’ because inflammation from the surgery can put stress on the endothelial cell layer. For those with Fuchs’, it may be reasonable to proceed with cataract surgery sooner than later, when the cataract is less dense as this allows for less stress on the corneal endothelium. Special attention is given to surgical techniques in patients with Fuchs’ disease.

Generally speaking, cataract surgery can achieve successful outcomes in patients with mild to moderate Fuchs’s dystrophy. Patients should work closely with their eye doctor to determine the best management plan including a comprehensive medical assessment of both the cataract and the Fuchs’ condition. It is impossible to predict how a cornea with Fuchs’ disease will respond to the mild stress of cataract surgery. Fortunately, there are good surgical procedures available for those whose Fuchs’ condition causes visually significant corneal swelling.