Clinical experience in rehabilitation of patients with Fuchs corneal dystrophy and cataract by ultrasonic phacoemulsification and descemetorhexis

BACKGROUND: The potential for peripheral corneal endothelial capabilities is a novel, poorly understood direction. The comprehensive development of various modifications of endothelial keratoplasty goes hand in hand with a lack of donor material. This explains the continuous search for safe tissue-preserving techniques.

AIM: The aim of this study is to evaluate the clinical and functional results of treatment of patients with Fuchs corneal dystrophy and cataract using a combination of cataract ultrasound phacoemulsification and descemetorhexis.

MATERIALS AND METHODS: The study included 3 patients (3 eyes), 3 women aged 65 to 78 (on average 73.6 ± 7.5 years). The follow-up period in the postoperative period was 36 months. The inclusion criteria were: patient complaints about glare, blurred vision and cloudy vision in the morning; the location of the guttae in the central 5 mm zone, central corneal stromal edema less than 610 microns, the inability to count endothelial cells in the center, endothelial cells density on the periphery in the upper quadrant more than 1400 cells/mm². All patients underwent phacoemulsification of cataract with IOL implantation and subsequent descemetorhexis in the 4 mm zone.

RESULTS: At 1 month — an increase in the central corneal thickness and a slight increase in uncorrected visual acuity (UCVA) and in best corrected visual acuity (BCVA). By the 3^rd month, positive dynamics was present: an increase in UCVA and BCVA in all cases, a decrease in the central corneal thickness (559 ± 20 μm), resorption of stromal edema, increase in corneal transparency, possibility to calculate the endothelial cells density in the center (866 ± 46 cells/mm²). At 36 months, the BCVA was 0.6, 0.4 and 0.5, respectively.

CONCLUSIONS: Restoration of corneal transparency was achieved in 100% of cases (3 out of 3). An analysis of the clinical results of the descemetorhexis + phacoemulsification + IOL operation demonstrated an increase in visual acuity, an increase in corneal transparency and a decrease in stromal edema in patients with initial Fuchs corneal dystrophy and cataract. The possibility of not using donor material for the treatment of Fuchs corneal dystrophy is a promising trend. Further accumulation of material is required.