Cataracts & Fuchs’ Corneal Dystrophy

Baltimore Washington Eye Center, Maryland

Tuesday, July 24, 2012

Cataracts & Fuchs’ Corneal Dystrophy

Baltimore Washington Eye Center Cataract Surgeons Arturo Betancourt, M.D. and Brad Spagnolo, M.D. want to share some information about Cataracts, Cataract Surgery and Fuchs’ Corneal Dystrophy. When evaluating patients for cataract surgery, it is very important to consider the health of a person’s cornea. The human cornea has several layers, each composed of specific kinds of cells. The innermost layer is called the endothelium. This layer is critical in keeping a person’s cornea clear and healthy. If the endothelium is abnormal, the cornea will swell in manner similar to how a sponge swells with wet. During a cataract exam, we look at the corneal endothelium for the presence of guttata. Guttata are wart-like, anvil-shaped or mushroom-shaped excrescences that represent abnormal basement membrane and collagen produced by the endothelium in some people. Guttata are seen often in older patients who have no visual problems. However, in a small number of people, guttata increase in number over many years (2-3 decades), ultimately leading to corneal swelling and decreased vision. When swelling develops, the condition is called Fuchs’ endothelial dystrophy. The frequency of cornea guttata increases with age. After age 40 years, 70% of patients have cornea guttata. Fortunately, however, only 0.1% of these patients will ever have corneal swelling. In patients with Fuchs’, the condition may ultimately require surgery to replace the abnormal endothelial layer. In the past, that meant a full-thickness corneal transplant, whereby a person’s unhealthy, swollen cornea is removed and replaced with a donor’s cornea. Today, if the only problem is the damaged endothelial layer, surgeons can replace just this layer with a donor endothelial layer. This procedure goes by several names, most commonly DSEK, which stands for Descemet’s Stripping Endothelial Keratoplasty. Since DSEK does not involve replacing the entire cornea, it is likely safer with a faster healing and recovery period. If we note significant guttata during a patient’s cataract surgery, we will discuss with them the fact that cataract surgery has some increased risk of producing corneal swelling and consequent decreased vision. In any patient, and particularly a patient with advanced guttata, a major goal of cataract surgery is to not cause any further damage to the corneal endothelium. During cataract surgery at Baltimore Washington Eye Center, we take steps to minimize any negative impact on a person’s cornea by using specialized gels to coat and protect the cornea endothelial layer. When placed appropriately and used judiciously, these gels create a protective “cocoon” that greatly diminish any insult to the cornea from the cataract surgery, thereby leading to excellent results for our patients. If you have cataracts, or have been told you need cataract surgery, be sure to ask your surgeon about the health of your cornea. If you have guttata, ask how significant they are and what impact this will have on your cataract surgery. 

If you or someone you know is concerned about cataracts, cataract surgery of Fuchs’ corneal dystrophy they are encouraged to schedule an eye examination at Baltimore Washington Eye Center by calling 800-495-3937, visiting Baltimore Washington Eye Center or 

Baltimore Washington Eye Center is a leading eye care practice serving the greater Baltimore and Washington, D.C. area staffed by a team of Ophthalmologists, Optometrists, Opticians, technical and administrative staff who provide eye examinations for adults and children, diagnosis and treatment of cataracts including cataract surgery and intraocular lens implants (IOL), laser vision correction such as LASIK, diagnosis and treatment of cornea disease, care for diseases of the retina including diabetes and age related macular degeneration (AMD) and diagnosis and treatment of glaucoma as well as contact lenses, eyeglasses, eyewear and optical services. Baltimore Washington Eye Center is conveniently located for patients from Arbutus, Carney, Clarksville, Columbia, Dundalk, Edgemere, Essex, Ellicott City, Ferndale, Glen Burnie, Kenwood, Laurel, Linthicum, Lutherville, Millersville, Odenton Owings Mills, Reisterstown, Towson, Parkville, Randallstown, Rivera Beach, Pasadena, Severna Park, South Gate and Woodlawn Maryland.