Femtosecond Laser–Assisted Cataract Surgery in Patients With Fuchs Endothelial Corneal Dystrophy
Patients suffering from Fuchs’ endothelial corneal dystrophy (FECD) present a challenge for cataract surgeon, as the surgery is associated with further endothelial cells lose, estimated for even 6-10% of cells. According to the available data, application of femtosecond laser decreases cumulative dissipated energy delivered by phacoemulsificator tip by 39-83% and reduces the time of the manual part of the procedure and the volume of irrigating solution.
Thirty-nine patients with cataract and medium-staged FECD were enrolled. All the subjects had clinically transparent corneas, although some presented subclinical stromal edema detectable by means of confocal microscopy. Cataract nuclei hardness were N2 to N5 according to LOCS III grading. The patients were followed up for minimum of 6 months. Preoperative and postoperative: mean minimal pachymetry (assessed by AS-OCT),mean central or paracentral endothelial density (assesed by ConfoScan) and BCVA were measured. All the surgeries were carried out using LensX (Alcon) femtolaser with SoftFit patient interface and Inifinity (Alcon) torsional phacoemulsification.
The patients were followed up for minimum of 6 months. Pre-operative mean minimal pachymetry (assessed by AS-OCT) was 552.87 µm (502-634), mean central or paracentral endothelial density (assessed by ConfoScan) 963 cells/mm² (430-1628), BCVA 0.36 (0.05-0.8). All the surgeries were carried out using LensX (Alcon) femtolaser with SoftFit patient interface and Inifinity (Alcon) torsional phacoemulsification. All the surgeries were uneventful. None of the patients developed clinically significant corneal edema after the surgery, in 7 cases minor or moderate edema or corneal folds were observed and retreated in few days after the surgery. BCVA improved to mean 0.71 (0.4-1.0), mean minimal pachymetry was 554.7 µm, (501-604), mean endothelial density 960 cells/mm² (440-1612).
Femtosecond-laser assisted cataract surgery was safe and effective procedure, reducing intraoperative trauma in patients with FECD. Proper preoperative assessment and appropriate technique of the manual part remain important for optimal outcomes.