corneal transplant/patch

[tfrost2002]

Our family Doctor indicated to my wife that she may be developing cataracts so I scheduled an appointment with an optometrist in St. Louis.  We saw the Doctor who did several tests and subsequently told my wife that her Corneal endothelial cell count was low (I think I have the term right).  He has referred her to a cornea specialist for a possible cornea transplant or patch.  

I am trying to learn all that I can to understand this diagnosis and treatment and would appreciate any help that I may be able to receive.  It is my plan to ask the Doctor's office for the exact diagnosis, cell count and treatment proposal before continuing my research but I thought I would ask here for advice and information.  

Any help would be greatly appreciated.  Thank you.

[John C Hagan III, MD, FACS, FAAO]

Many patients and many posters on all the over 300+ health forums think that "with routine surgery there should never be any complications"  So we take every opportunity to remind everyone medicine, surgery, medications and life have complications. Best of luckk

JCH MD

[tfrost2002]

Thank you for taking the time to answer all my questions and in such a professional manner.  "Of course there are complications" how helpful.

[John C Hagan III, MD, FACS, FAAO]

Of course there are complications. They cannot be individualized for your case without an examination. John Doane MD of our Discover Vision Centers is one of the most accomplished surgeons I have every seen. He has an international reputation, has written textbooks, published research papers and edited eye surgery journal. I think he's among the absolute best in the world for cornea and refractive surgery.

JCH MD

[tfrost2002]

I read this along with several others on this subject, thank you.  I noticed that another doctor in your office has performed the newer technique a number of times.  What has his success rate been?  Have there been any significant complications with that type of surgery?  Should my wife be tested by another doctor to determine if the findings are correct or is the testing definitive?  Thank you for your help.

[John C Hagan III, MD, FACS, FAAO]

The most common cause of reduced corneal endothelial cell count is Fuch's Dystrophy. Here is a previous answer about the condition. Guttatta are bumps that form on the inside of the cornea when the cell count is low. WIth modern small incision cataract surgery and cushioning fluids (viscoelastics) even very low cell counts (less than 800 cells square mm) can survive catactact surgery. Here is the previous discussion:

There is no exact definition of how many guttatta it takes to diagnosis Fuchs' Endothelial Corneal Dystrophy. Some guttatta are part of aging and do not ever become a problem. Two tests that are often helpful are corneal endothelial cell counts (the number decreases as the disease develops and progresses) and corneal pachymetry (corneal thickness) the thickness increasing as the disease develops and progresses. Family history is useful as many cases of Fuchs' are hereditary (affecting females more than males). Guttata are 'bumps' that develop on the back of the cornea when there are not enough endothelial cells to cover it. These cells are very important as they pump fluid out of the cornea and into the anterior chamber of the eye. The cornea is hydrophilic (water loving) like a sponge. When it swells and gets thicker it starts to become cloudy and blur the vision. When this happens and the impairment is severed than a corneal transplant is indicated. Recently a new operation for decompensated Fuchs' dystrophy called DSEAK (Descemet's membrane epithelial automated keratoplasty) has dramatically speeded the healing, safety and results over full thickness penetrating keratoplasty. Corneal endothelial cells do not multiply or replace themselves when damaged or cell death occurs.

Cataract surgery will not cause Fuchs' dystrophy but cataract surgery (or for that matter any surgery inside the eye) will stress the cornea and in severe Fuchs' could be the final straw that causes the cornea to compensate.

Your doctor is absolutely correct. In my patients with progressive Fuchs's dystrophy I recommend cataract surgery SOONER rather than later because the advanced, "hard" cataract will put much more stress and strain on the cornea endothelium than a moderately firm or softer cataract. Fuchs' dystrophy can decompensate on its own without any surgery taking place or any cataract in the eye.

It would be helpful to know if your mother's problem with her eye's was Fuchs' dystrophy. It is unusual for Fuchs' to cause an eye to be removed, so there's a good chance she had something else.

I would go ahead and have the cataract surgery when you vision starts to be a moderate problem for you and the cataract is the cause. By using the endothelial cell count and corneal thickness, your ophthalmologist can give you a reasonable risk of the cornea being able to stand your cataract surgery.

Good luck, new cataract surgical techniques are much, much more gentle on the eye than techniques used in the past.

JCH MD

[tfrost2002]

I am sorry I said optometrist and I meant ophthalmologist.