Combined Endothelial Keratoplasty with Cataract surgery in a patient with Fuch’s Endothelial Corneal Dystrophy

Mrs X had come to our OPD with blurring of vision in right eye for few months. On evaluation she was found to have cloudy cornea in right eye and abnormal cells in the back layer of the cornea called guttae in the left (Fig 1). The diagnosis was Fuchs corneal endothelial dystrophy with cataract in both eyes (Right > Left). Her vision in right eye was counting fingers at 2 metres only (2/60) and left eye had 6/9 vision.

 

Fuchs corneal dystrophy is a disease involving the back layer of the cornea where the endothelial cells are dysfunctional leading to corneal swelling and vision loss. In these cases, patients require a corneal transplantation for vision restoration.

 

Recent advancement in corneal transplantation surgery involve selective replacement of the diseased cornea using component corneal transplantation techniques i.e. only the abnormal layer is selectively replaced. In this patient since the disease primarily involves only the endothelial cells, endothelial keratoplasty surgery was done (DSAEK - Descemet Stripping Automated Endothelial Keratoplasty). It has significant advantages that surgery requires few or no sutures, quick postoperative recovery, lesser incidence of graft related complications like rejection/ infection.

 

Since our patient had both Fuchs dystrophy with significant cataract in the same eye, it was decided to proceed with a combined surgery of DSAEK and cataract surgery in the same sitting to avoid the need for another surgery and for better visual outcomes and success of the graft. After surgery patient had a clear cornea with well attached DSAEK corneal graft and intraocular lens in place (Fig 2). Her vision was restored to near normal and the patient was happy and satisfied.

 

This case highlights the successful outcome of a combined endothelial keratoplasty surgery (DSAEK) with cataract surgery. At Medanta, we routinely perform all forms of corneal transplantation techniques.

 

Right eye of the patient showing cloudy cornea due to swelling Post- op picture of the patient showing clear cornea with well attached DSAEK graft and intraocular lens (IOL)

 

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