fuchs & cataracts

My mother-in-law has cataracts and also suffers from Fuchs syndrome. Several years ago, her opthamologist told her he would not remove the cataracts because of the Fuchs. On her visit today, he told her the cataracts had worsened and needed to be removed.  Does having Fuchs pose additional risks for the cataracts surgery procedure?

[Michael J Kutryb, MD]

Absolutely, it carries added risk that there could be corneal edema or swelling with delayed clearing of the vision and occasionally complete failure of the cornea requiring a corneal transplant procedure like DSAEK.  I always do a complete corneal evaluation on every cataract surgery patients and know exactly the number and condition of the endothelial cells (the cells that die in Fuch's corneal dystrophy.)  Sometimes I actually delay the surgery because the cataract surgery can make the vision worse.  Each case needs to be evaluated separately.  Later down the road if DSAEK surgery is needed, the patients generally do quite well but rarely see better than 20/30 or 20/40.  In the end it depend on how bad the Fuch's is.  I've done hundreds of cases in patients with mild Fuch's and they have all done well (provided of course that I took special precautions like extra viscoelastic, careful phacoemulsification with limited power use.)  I use OZIL torsional phaco or Whitestar phaco now for all Fuch's cases. Much gentler on the eye.

MJK MD