Cataract Surgery and Fuch's

[DragonLensmanWV]

I have a friend and fellow (at least former in my case) -15.
He called me today and has cataract surgery scheduled soon. He's not using the same surgeon as I did. I think his surgeon is a competent surgeon (no adverse problems of his surgeries have we seen) but I just don't like the guy on a personal basis.
Anyway, my friend informed me that he is having to have some special implants made that will take three extra weeks. This is because he has Fuch's and he is also informed that he may have to have a corneal transplant, possibly at the same time as cataract surgery. This concerns him, of course.
Have any of you experienced treating Fuch's in a situation like this?
I just need a little more info as to how this is handled.

[Chris Ryser]

I just need a little more info as to how this is handled.

FuchsSupportIf it doesn't have our "Eye with a Heart" Logo,Then it isn't genuine Fuchs' Support!!!!!Fuchs' Corneal Dystrophy

http://www.fuchsdystrophy.org/

[Ory]

Do a quick search online for DSAEK - descemet stripping with automated endothelial keratectomy. New-ish procedure where they transplant the endothelium from a donor cornea to control Fuchs and other dystrophies. That may be what he's getting. Seems to work about 70% of the time; the remaining 30% still end up with the transplant.

[DragonLensmanWV]

Do a quick search online for DSAEK - descemet stripping with automated endothelial keratectomy. New-ish procedure where they transplant the endothelium from a donor cornea to control Fuchs and other dystrophies. That may be what he's getting. Seems to work about 70% of the time; the remaining 30% still end up with the transplant.

Ah. I see now. Thank you very much for that info. I had found this
http://www.revoptom.com/HANDBOOK/SECT29a.HTM
which seems to cover Fuch's pretty well.
Since his surgeon has done very few transplants, and I don't know if he's done ANY DSAEK, I'm going to recommend he:
1. Find out more just what the local surgeon plans.
2. If he does need a corneal transplant, I'll recommend he get it done in Lexington, where one of my optician's mother (95 years old) just had it done with zero problems.
3. Not let the local surgeon rush him.

Does the corneal transplant and/or DSAEK provide a "cure" or just "treatment"?

[Ory]

Typically a cure if it works. Basically the issue with Fuchs is loss of endothelium leads to increased corneal edema - the endothelium's job is to pump out the extra fluid. If you replace the original pump system with a donor one, it should work reasonably well.

[DoubleD]

My mother in law just finished with second corneal transplant- due to Fuchs syndrome. Things have been healing great, and she's done fine. Note it takes about a year for single transplant to near fully heal. While she had cataract surgery (IOL) earlier on, plus minor glacoma now, I would say it would be rare to accomplish both IOL and transplant at same time. I could be wrong...
Denny

[nickrock]

I will chime in here and shead some light (I hope). Depending on the severity of Fuchs, your friend may be entriely worse off after cataract surgery withOUT a DSEK procedure at the same time. (DSEAK is older, no longer "automated.") i.e. Healthy corneas can get edema s/p cataract surgery, even pseudophakic bullous keratopathy, or complete endothelial decomp or failure.
I would highly encourage your friend to be extremely cautious about who he has as his surgeon and I would recommend a fellowship trained corneal specialist, preferablly in a University setting. I also think that the 70% statistic mentioned ealier in this thread is WAY off base. Mary Terry, MD, one of the pioneering surgeons of this transplant technique, reports a 95% succes rate of transplanted donor tissue.
If your friend's surgeon thinks that he should have or need a PKP (penetrating keratoplasy AKA Full thickness transplant) he should run for the door as soon as possible.

[DragonLensmanWV]

Thanks, Nick. Good advice. He should be in to see me tomorrow and I'll show him this thread.

[nickrock]

No problem. I am glad I could help. I work with a group of corneal specialists and I see patient's like your friend on a daily basis. I am sure there are some wonderful corneal specialists in WV, I just don't know who they are. If your friend is willing to travel a bit, one of the most well known corneal specialists in the nation is Francis Price Jr., MD in Indianapolis. Here is a link from his website:
http://www.pricevisiongroup.com/fuchs_dystrophy.html
He is also a specialist in Endothelial keratoplasty (EK) which is what the DSEK surgery is. I don't know him personally, but he is world renowned. His associate and partner in practice, Erik Letko, MD, I do know personally and he is an exceptional surgeon and corneal specialist as well.
Anywho, tell your friend good luck and there is no such thing as knowing too much about your own health and diagnoses.