# The surgical management of a patient with Fuchs endothelial dystrophy and cataracts

## TL;DR

This paper compares two surgical approaches for a patient with Fuchs endothelial dystrophy and cataracts, showing that Descemet membrane endothelial keratoplasty (DMEK) leads to faster visual recovery.

## Contribution

The study presents a comparative case report of two surgical techniques for Fuchs dystrophy with cataracts and highlights DMEK's advantages in visual recovery.

## Key findings

- DMEK in the left eye resulted in quicker visual acuity improvement compared to penetrating keratoplasty in the right eye.
- DMEK is shown to be a viable and effective treatment for advanced Fuchs endothelial dystrophy with good long-term graft survival.
- AS-OCT monitoring proved useful in tracking pre- and post-surgery corneal changes.

## Abstract

Objective: To report the two different surgical approaches in the case of a patient with Fuchs endothelial dystrophy with low endothelial cell count and advanced cataracts.

Methods: The chosen surgical approach differed between eyes, with the right eye undergoing a combined approach consisting of cataract surgery, intraocular lens implantation, and penetrating keratoplasty in 2022. One year later, for the left eye, a different approach was decided: cataract surgery followed by Descemet membrane endothelial keratoplasty (DMEK). The Descemet membrane graft was prepared by the surgeon using the liquid bubble technique. AS-OCT was used to monitor the patient before and after surgery.

Results: Visual recovery was excellent for both eyes, however, visual acuity improved quickly in the left eye (DMEK), while, in the right eye (PK), the best corrected visual acuity was reached after several months post-surgery.

Conclusion: Advanced stages of Fuchs dystrophy patients will most likely need corneal transplantation. Each type of corneal transplantation procedure comes with unique challenges, both intraoperative and postoperative. DMEK is a very good treatment option for patients with Fuchs endothelial dystrophy, with excellent visual recovery and good graft survival at the 10-year mark.

Abbreviations: DMEK = Descemet membrane endothelial keratoplasty, PK = penetrating keratoplasty, AS-OCT = anterior segment optical coherence tomography, FECD = Fuchs endothelial corneal dystrophy, BCVA = best corrected visual acuity, US = ultrasound, CDE = cumulative dissipated energy, IOL = intraocular lens