Cataract Surgery and Fuchs Dystrophy
At SightMD, we specialize in cataract surgery. A cataract is a clouding of the natural lens of the eye. This defective lens is removed by our board certified cataract surgeons using gentle computer controlled ultrasound called phacoemulsification (phaco). This is done at our surgery center using eye drop anesthesia with IV sedation. Once the cataract is removed in cataract surgery, a new intraocular lens implant is placed. There are several types of implants or IOLs including premium implants that allow our patients to see far and near with less dependence on glasses and contact lenses. There is also the TORIC® implant by Alcon that reduces or eliminates astigmatism from the visual system. There have been many advances in cataract surgery that allow our eye surgeons to deliver cataract surgery without painful injections, stitches, or even an eye patch following the procedure. Every patient knows others that have had a successful experience with cataract surgery, but there are some clinical conditions that can make cataract surgery more difficult. The expertise and experience of the eye doctors at our eye care practice gives our patients the best chance at a fantastic outcome.
Fuchs’ dystrophy is an inherited corneal weakness that can be progressive. The cornea is the front window of the eye or the clear dome that covers the iris. In Fuchs’ dystrophy, the inner most layer of the cornea called the endothelium becomes deficient. The purpose of the endothelium is to pull fluid out of the cornea, keeping it clear. If the endothelium does not function properly, the cornea can become swollen leading to a hazy cornea. A cloudy cornea makes vision blurry as if the patient were looking through a dirty window. In the worst cases, the endothelium needs to be replaced in a corneal operation.
Cataract surgery is performed between the iris and the back surface of the cornea in a space called the anterior chamber. The cataract or cloudy lens of the eye is located immediately behind the iris. In cataract surgery, a small circular opening called a capsulorhexis is made in the front of the cataract capsule or skin. The cataract is then broken into pieces and these pieces are brought forward and removed using ultrasound called phaco. This ultrasound energy can stress the cornea causing swelling which temporarily makes the cornea cloudy. The ultrasound energy is very low in modern cataract surgery and when the cornea is normal, it recovers easily and may even be completely clear on the first day after surgery. When the cornea is weak like in Fuchs’ dystrophy, it is not able to deal with the stress of cataract surgery as well as a normal cornea. There can be more severe corneal swelling and in rare cases, the cornea may fail. If the cornea fails, the patient would need additional corneal surgery.
In most cases of Fuchs’ dystrophy, our cataract surgeons are able to fully preserve the cornea by using special gels during cataract surgery called viscoelastics. Certain viscoelastic gels are known to be more corneal protective. In addition, our eye surgeons minimize ultrasound energy and use cataract surgery techniques that are minimally disruptive to the cornea. Recent advances in cataract surgery technology have allowed the cataract surgeons at SightMD to deliver the safest and most efficient cataract treatment to date.