Fuchs Dystrophy and Cataract: Diagnosis, Evaluation and Treatment

Corneal endothelium maintains corneal hydration and clarity. Fuchs endothelial corneal dystrophy (FECD) affects the endothelium, causing edema and guttae on Descemet’s membrane. Descemet membrane endothelial keratoplasty (DMEK) has become standard of care for FECD with excellent visual outcomes. Many patients with FECD also have cataracts; cataract surgery increases the risk of corneal decompensation and influences intraocular lens (IOL) choice and visual outcomes. Combining surgeries raises questions about timing and sequence of DMEK and cataract extraction. This review guides corneal surgeons in choosing endothelial keratoplasty and cataract surgery—alone, combined, or sequential—for FECD patients. Key Summary Points: FECD causes decreased vision; DMEK (replacement of diseased DM and endothelium) is current standard therapy; coexisting cataracts affect vision; decision-making incorporates history, exam, diagnostic tests (tomography, specular microscopy, pachymetry), practice patterns and patient preferences; a literature review helps navigate these choices.

Muhammad Ali, Cho Kyongjin, Srikumaran Divya