Treatment of Fuchs' Endothelial Corneal Dystrophy with Visually Significant Cataract

Clinical Scenario

This protocol covers early Fuchs' endothelial corneal dystrophy (FECD) in patients who also have a visually significant cataract. The coexistence of compromised corneal endothelium and lens opacity creates specific surgical planning considerations that differ from either condition managed in isolation.

Approach

A staged surgical strategy is recommended — cataract surgery is addressed first, employing techniques specifically selected to protect the compromised corneal endothelium, before any subsequent corneal procedure is considered.

Full technique details, sequencing criteria, and step-by-step guidance are available in the complete protocol below.

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References

DOI: 10.1146/annurev-vision-091718-014852

Cataract surgery before EK is recommended in patients with early FECD and visually significant cataract.
As part of staged initial cataract surgery, phacoemulsification time should be kept low and endothelial protection should be provided by viscoelastic material.
The "soft-shell" technique using cohesive and dispersive types of viscoelastic devices effectively protects the compromised endothelium in FECD patients.

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