Can I have corneal and cataract surgery at the same time?
DEC 09, 2019
I am 77 and have Fuchs’ dystrophy and also need cataract surgery. Can cataract surgery and corneal transplant (endothelium, for Fuchs’) be done at the same time? If so, what is the success rate, and should I even have these done at my age?
When patients have both Fuchs' corneal dystrophy and cataracts, the ophthalmologist needs to find out which condition is most responsible for the patient's visual decline. In some cases, only one of the conditions may need to be addressed. If the visual decline is mainly due to the cataract, and cataract surgery can be done without causing the cornea to permanently swell, then cataract surgery alone is the preferred treatment option. If Fuchs' dystrophy is the major cause for the symptoms, sometimes a transplant alone is performed without touching the cataract.
If your ophthalmologist believes that performing cataract surgery will cause the Fuchs' dystrophy to permanently swell, or if performing a corneal transplant will cause the cataract to become visually significant, he or she may opt to do a combined procedure (cataract surgery along with a partial or full thickness corneal transplant). My personal preference is not to do them at the same time, but instead to stage them one after the other. I often do the cataract surgery first to see if the cornea will recover prior to deciding if a transplant will be necessary. Unfortunately, this strategy calls for multiple trips to the operating room rather than getting it all done at the same time. Ophthalmologists have their own personal preference and you should discuss these issues with your doctor.
Advanced age only plays a role when discussing the recovery time needed from a surgical procedure. Often in partial thickness transplants, it may take three months for the vision to recover. In full thickness transplants, it can be over a year. A patient may not want to go through that recovery period of having often poorer vision during that time if they are of an older age. Also, as patients age, other health problems arise that may prevent surgical clearance for anesthesia (pain management, which can include loss of sensation as well as unconsciousness).