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Low cell density in cataract surgery remains a challenge

Can patients' vision improve from cataract surgery alone?

Dermot McGrath

Posted: Sunday, September 15, 2019

Vincenzo Scorcia

Cataract surgery in cases of low endothelial cell density remains a challenging proposition even for more experienced surgeons, according to Vincenzo Scorcia MD.

“It makes it a difficult decision for the surgeon to decide whether to proceed with cataract surgery alone or to combine it with keratoplasty,” he told delegates attending the joint ESCRS/EuCornea Symposium at the 37th ESCRS Congress.

Dr Scorcia said that there are several issues to be addressed before embarking on cataract removal in patients with pathologies such as Fuchs’ endothelial dystrophy or those who had previously undergone penetrating keratoplasty.

“We need to ask if the patient could improve their vision from cataract surgery alone. We also need to assess the risk of corneal decompensation after cataract surgery and determine which preoperative parameters should be considered as risk factors for corneal failure,” he said.

Up to 90% of Fuchs’ patients who underwent cataract surgery did not need corneal transplants and achieved a postoperative best-corrected visual acuity of 20/35, said Dr Scorcia.

“In a large number of cases, opting for cataract extraction alone despite endothelial pathology may be a good option because the patients are often satisfied with less than perfect visual outcomes and it avoids the potential complications associated with endothelial keratoplasty,”  he said.